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High pre-operative fasting blood glucose levels predict a poor prognosis in patients with pancreatic neuroendocrine tumour

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Abstract

Background

Hyperglycaemia has been indicated as a pro-tumoural factor; however, the prognostic role of diabetes mellitus (DM) in pancreatic neuroendocrine tumours (panNETs) remains ambiguous, partly due to the effects of anti-diabetic drugs. We hypothesise that the blood sugar level per se affects the outcome of panNETs, and thus, we investigated the prognostic significance of the fasting blood glucose (FBG) level in resected panNET patients with no pre-existing DM.

Methods

A retrospective cohort study comprising 201 patients with radically resected non-functional panNETs was conducted. A total of 164 patients without pre-existing DM were further studied. An FBG level greater than 5.6 mmol/L was defined as high (otherwise, normal). Survival was evaluated using Kaplan–Meier methods and log-rank tests. Multivariate analyses for survival were performed using the Cox regression model.

Results

High FBG levels were significantly associated with poor overall survival (OS; p = 0.019) and recurrence-free survival (RFS; p = 0.011) in resected patients with panNET who had no pre-existing DM. The multivariable-adjusted hazard ratios (HRs) for mortality and recurrence comparing patients with high and normal FBG levels were 12.19 (95% confidence interval (CI) = 1.15–128.78, p = 0.038) and 2.43 (95% CI = 1.03–5.72, p = 0.042), respectively.

Conclusion

A pre-operative FBG level greater than 5.6 mmol/L is associated with poor OS and RFS metastasis for patients with panNET who undergo radical surgical resection.

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Funding

This work was supported by the National Natural Science Foundation of China (grant numbers 81625016, 81871940, 81902417), the Scientific Innovation Project of Shanghai Education Committee (2019-01-07-00-07-E00057), Clinical and Scientific Innovation Project of Shanghai Hospital Development Centre (SHDC12018109), the Shanghai Natural Science Foundation (grant number 17ZR1406300), the Shanghai Cancer Centre Foundation for Distinguished Young Scholars (grant number YJJQ201803), and the Fudan University Personalised Project for “Double Top” Original Research (grant number XM03190633).

Author contributions

All authors contributed to the study conception and design. C.L. and X.Y.: conceptualisation and funding acquisition. P.Z., Z.F., K.J. and H.C.: resources and investigation and data curation. S.D., Q.H. and Y.Q.: project administration. Q.N. and G.L.: review and editing. Y.G. and Z.F.: formal analysis and software and writing—original draft. All authors read and approved the final paper.

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Author notes

  1. These authors contributed equally: Yitao Gong, Zhiyao Fan, Pin Zhang

Authors and Affiliations

  1. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 200032, Shanghai, China

    Yitao Gong, Zhiyao Fan, Pin Zhang, Yunzhen Qian, Qiuyi Huang, Shengming Deng, Guopei Luo, He Cheng, Kaizhou Jin, Quanxing Ni, Xianjun Yu & Chen Liu

  2. Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China

    Yitao Gong, Zhiyao Fan, Pin Zhang, Yunzhen Qian, Qiuyi Huang, Shengming Deng, Guopei Luo, He Cheng, Kaizhou Jin, Quanxing Ni, Xianjun Yu & Chen Liu

  3. Shanghai Pancreatic Cancer Institute, 200032, Shanghai, China

    Yitao Gong, Zhiyao Fan, Pin Zhang, Yunzhen Qian, Qiuyi Huang, Shengming Deng, Guopei Luo, He Cheng, Kaizhou Jin, Quanxing Ni, Xianjun Yu & Chen Liu

  4. Pancreatic Cancer Institute, Fudan University, 200032, Shanghai, China

    Yitao Gong, Zhiyao Fan, Pin Zhang, Yunzhen Qian, Qiuyi Huang, Shengming Deng, Guopei Luo, He Cheng, Kaizhou Jin, Quanxing Ni, Xianjun Yu & Chen Liu

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  1. Yitao Gong
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Correspondence to Xianjun Yu or Chen Liu.

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The authors declare that they have no conflict of interest.

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Ethical approval was waived by the Ethics Board of Shanghai Cancer Centre, Fudan University in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Informed consent was obtained from all individual participants included in the study.

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Gong, Y., Fan, Z., Zhang, P. et al. High pre-operative fasting blood glucose levels predict a poor prognosis in patients with pancreatic neuroendocrine tumour. Endocrine 71, 494–501 (2021). https://doi.org/10.1007/s12020-020-02469-0

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  • DOI: https://doi.org/10.1007/s12020-020-02469-0

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