title: Prognostic relevance of preoperative diabetes mellitus and the degree of hyperglycemia on the outcomes of resected pancreatic ductal adenocarcinoma.
abstract: BACKGROUND
  The prognostic relevance of preoperative diabetes mellitus (DM) on the outcomes of resected pancreatic ductal adenocarcinoma (PDAC) is controversial. Most previous studies evaluated the prognostic role of DM based on a single blood test.
  
  
  METHODS
  The participants included 147 patients with PDAC who underwent pancreatectomy between September 2003 and June 2012. They were divided into following groups according to the preoperative DM and degree of hyperglycemia defined by glycosylated hemoglobin (HbA1c): non-DM (n = 70), DM with HbA1c < 9.0% (n = 52), and DM with HbA1c ≥ 9.0% (n = 25).
  
  
  RESULTS
  There were no significant differences in cancer stage or postoperative complications among the three groups. The survival rate was significantly lower in the DM with HbA1c ≥ 9.0% group (22.3%) than in the non-DM group (33.6%) and the DM with HbA1c < 9.0% group (33.8%) (P = 0.044). Multivariate analysis revealed that DM with HbA1c ≥ 9.0% (hazard ratio [HR] 2.495, 95% confidence interval [CI] 1.274-4.886, P = 0.008) and the presence of venous invasion (HR 1.836, 95%CI 1.072-3.146, P = 0.027) were independent prognostic factors for survival.
  
  
  CONCLUSIONS
  Uncontrolled severe hyperglycemia rather than preoperative DM negatively affects the survival outcomes following PDAC resection.
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.
authors.forename: Woohyung
authors.initials: W
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.
authors.forename: Yoo-Seok
authors.initials: YS
authors.lastname: Yoon
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.
authors.forename: Ho-Seong
authors.initials: HS
authors.lastname: Han
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.
authors.forename: Jai Young
authors.initials: JY
authors.lastname: Cho
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.
authors.forename: YoungRok
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.
authors.forename: Jae Yool
authors.initials: JY
authors.lastname: Jang
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.
authors.forename: Hanlim
authors.initials: H
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D001786:Blood Glucose / Q000378:metabolism; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D048909:Diabetes Complications / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000150:complications; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D014408:Biomarkers, Tumor; D001786:Blood Glucose; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: diabetes mellitus; glycosylated hemoglobin; pancreatic cancer