Preoperative Diabetes Mellitus and Long-Term Survival After Resection of Pancreatic Adenocarcinoma

Carrie K. Chu MD, Ashley E. Mazo BS, Michael Goodman MD, MPH, Vasili Egnatashvili MD, Juan M. Sarmiento MD, Charles A. Staley MD, John R. Galloway MD, N. Volkan Adsay MD, Sol Jacobs MD, David A. Kooby MD
Pancreatic Tumors
Volume 17, Issue 2 / February , 2009

View full article HTML | View full article PDF | Download Citation

Abstract

Purpose

To assess clinicopathologic features and postresection survival of diabetes mellitus (DM)-associated pancreatic ductal adenocarcinoma (PDAC).

Methods

Records of resected PDAC patients from 2000 to 2007 were reviewed. DM was classified as new-onset (<24 months before PDAC) or longstanding (≥24 months). Clinicopathologic features were compared by univariate and multivariate analyses. Survival was assessed by Kaplan–Meier method and Cox regression.

Results

Of 209 patients, 93 (45%) met criteria for DM (35 longstanding DM, 55 new-onset DM, 3 duration unknown). DM patients were older (DM 66 ± 9 years, non-DM 63 ± 12 years, P = 0.06); a majority had additional preoperative comorbidities (DM 64.5%, non-DM 25.9%, P < 0.001). Tumor size was larger in patients with DM (DM 3.8 ± 1.7 cm, non-DM 3.2 ± 1.5 cm, P = 0.003). Groups were similar in terms of tumor location, perineural/lymphovascular invasion, and node and margin status. On logistic regression, tumor size ≥3.0 cm was independently associated with both overall DM (odds ratio [OR] 3.60; 95% confidence interval [1.79–7.26]) and new-onset DM (OR 3.69, [1.65–8.24]). Median survival was reduced in patients with DM compared with non-DM (15 versus 17 months, P = 0.015). Multivariate analysis controlling for prognostic variables including age, comorbidities, and tumor size demonstrated that DM was independently associated with reduced survival (hazard ratio [HR] 1.55, [1.02–2.35]). This association was more pronounced for patients with new-onset DM (HR 1.75 [1.10–2.78]) than those with longstanding DM (HR 1.30 [0.75–2.25]).

Conclusions

Preexisting DM is associated with reduced survival in patients undergoing resection for PDAC. PDAC with new-onset DM may exhibit increased tumor size and decreased postresection survival. Additional investigation is needed to clarify etiology and impact of PDAC-associated DM.

Go to Issue Contents