title: Multi-institutional analysis of pancreatic adenocarcinoma demonstrating the effect of diabetes status on survival after resection.
abstract: BACKGROUND
  The effect of diabetes on survival after resection pancreatic ductal carcinoma (PDAC) is unclear. The present study was undertaken to determine whether pre-operative diabetes has any predictive value for survival.
  
  
  METHODS
  A retrospective review from seven centres was performed. Metabolic factors, tumour characteristics and outcomes of patients undergoing resection for PDAC were collected. Univariate and multivariable analyses were performed to determine factors associated with disease-free (DFS) and overall survival (OS).
  
  
  RESULTS
  Of the 509 patients in the present study, 31.2% had diabetes. Scoring systems were devised to predict OS and DFS based on a training set (n= 245) and were subsequently tested on an independent set (n= 264). Pre-operative diabetes (P < 0.001), tumour size >2 cm (P= 0.001), metastatic nodal ratio >0.1 (P < 0.001) and R1 margin (P < 0.001) all correlated with DFS and OS on univariate analysis. Scoring systems were devised based on multivariable analysis of the above factors. Diabetes and the metastatic nodal ratio were the most important factors in each system, earning two points for OS and four points for DFS. These scoring systems significantly correlated with both DFS (P < 0.001) and OS (P < 0.001).
  
  
  CONCLUSIONS
  Pre-operative diabetes status provides useful information that can help to stratify patients in terms of predicted post-operative OS and DFS.
authors.affiliation: Surgery, University of Louisville, Louisville, KY 40202, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Cannon
authors.forename: Ryan
authors.initials: R
authors.lastname: LeGrand
authors.forename: Ryaz B
authors.initials: RB
authors.lastname: Chagpar
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
authors.forename: Rebecca
authors.initials: R
authors.lastname: McClaine
authors.forename: Hong Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Christopher
authors.initials: C
authors.lastname: Rupp
authors.forename: Cliff S
authors.initials: CS
authors.lastname: Cho
authors.forename: Adam
authors.initials: A
authors.lastname: Brinkman
authors.forename: Sharon
authors.initials: S
authors.lastname: Weber
authors.forename: Emily R
authors.initials: ER
authors.lastname: Winslow
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.forename: Carrie K
authors.initials: CK
authors.lastname: Chu
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.forename: Ian
authors.initials: I
authors.lastname: Glenn
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Parikh
authors.forename: Nipun B
authors.initials: NB
authors.lastname: Merchant
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.forename: Glenda G
authors.initials: GG
authors.lastname: Callender
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D003661:Decision Support Techniques; D003920:Diabetes Mellitus / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049451:Nomograms; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality*; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D014481:United States / Q000453:epidemiology