title: Impact of diabetes mellitus on the survival of pancreatic cancer: a meta-analysis.
abstract: BACKGROUND
  Diabetes mellitus (DM) is a risk factor for pancreatic cancer (PC), but its prognostic value in PC is still unclear. To elucidate this issue, we systematically reviewed the evidence concerning the association between diabetes status and PC.
  
  
  METHODS
  Medline and EMBASE databases were searched to identify the eligible studies. Overall and subgroup analyses were performed to detect the discrepancy of prognosis according to diabetes status. Hazard ratios (HRs) with 95% CI were used to estimate the effect size.
  
  
  RESULTS
  Eighteen studies including 16,181 patients with sample size ranging from 113 to 4,658 were pooled in this meta-analysis. Results showed that patients with DM had worse survival (HR 1.19, 95% CI: 1.07-1.32). In view of the impact of diabetes duration and tumor stage on the outcomes, we classified the studies into different groups. The results indicated that DM was associated with survival in both long-standing diabetes (HR 1.26, 95% CI: 1.14-1.40) and recent-onset diabetes (HR 1.29, 95% CI: 1.09-1.51). Data regarding localized disease (HR 1.57, 95% CI: 1.00-2.46) and nonlocalized (locally advanced and metastatic) disease (HR 1.42, 95% CI: 1.16-1.73) verified that the prognostic value was independent of tumor stage.
  
  
  CONCLUSIONS
  Our results suggested that patients with DM were associated with worse survival than those without DM. Diabetes may be a predictive factor of survival in patients with PC. Surveillance of diabetes status and antidiabetes medication administration after the diagnosis of PC is of clinical importance.
authors.affiliation: Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors.forename: Hui
authors.initials: H
authors.lastname: Shen
authors.affiliation: Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhan
authors.affiliation: Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors.forename: Dong
authors.initials: D
authors.lastname: Yang
authors.affiliation: Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
keywords: diabetes mellitus; meta-analysis; pancreatic cancer; survival