title: Preoperative diabetes mellitus and long-term survival after resection of pancreatic adenocarcinoma.
abstract: OBJECTIVE
  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 (> or =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.
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Carrie K
authors.initials: CK
authors.lastname: Chu
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Mazo
authors.forename: Michael
authors.initials: M
authors.lastname: Goodman
authors.forename: Vasili
authors.initials: V
authors.lastname: Egnatashvili
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sarmiento
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.forename: John R
authors.initials: JR
authors.lastname: Galloway
authors.forename: N Volkan
authors.initials: NV
authors.lastname: Adsay
authors.forename: Sol
authors.initials: S
authors.lastname: Jacobs
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D048909:Diabetes Complications / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D057234:Preoperative Period; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome