title: The impact of diabetes mellitus on survival following resection and adjuvant chemotherapy for pancreatic cancer.
abstract: Diabetes mellitus is frequently observed in pancreatic cancer patients and is both a risk factor and an early manifestation of the disease.
  
  
  
  We analysed the prognostic impact of diabetes on the outcome of pancreatic cancer following resection and adjuvant chemotherapy using individual patient data from three European Study Group for Pancreatic Cancer randomised controlled trials. Analyses were carried out to assess the association between clinical characteristics and the presence of preoperative diabetes, as well as the effect of diabetic status on overall survival.
  
  
  
  In total, 1105 patients were included in the analysis, of whom 257 (23%) had confirmed diabetes and 848 (77%) did not. Median (95% confidence interval (CI)) unadjusted overall survival in non-diabetic patients was 22.3 (20.8-24.1) months compared with 18.8 (16.9-22.1) months for diabetic patients (P=0.24). Diabetic patients were older, had increased weight and more co-morbidities. Following adjustment, multivariable analysis demonstrated that diabetic patients had an increased risk of death (hazard ratio: 1.19 (95% CI 1.01, 1.40), P=0.034). Maximum tumour size of diabetic patients was larger at randomisation (33.6 vs 29.7 mm, P=0.026).
  
  
  
  Diabetes mellitus was associated with increased tumour size and reduced survival following pancreatic cancer resection and adjuvant chemotherapy.
authors: Liverpool Cancer Research UK Cancer Trials Unit, Liverpool Cancer Research UK Centre, University of Liverpool, Liverpool, UK.|NIHR Pancreas Biomedical Research Unit, University of Liverpool, Liverpool L69 3GA, UK.
authors: Jörg
authors: J
authors: Kleeff
authors: Liverpool Cancer Research UK Cancer Trials Unit, Liverpool Cancer Research UK Centre, University of Liverpool, Liverpool, UK.|NIHR Pancreas Biomedical Research Unit, University of Liverpool, Liverpool L69 3GA, UK.
authors: Eithne
authors: E
authors: Costello
authors: Liverpool Cancer Research UK Cancer Trials Unit, Liverpool Cancer Research UK Centre, University of Liverpool, Liverpool, UK.|NIHR Pancreas Biomedical Research Unit, University of Liverpool, Liverpool L69 3GA, UK.
authors: Richard
authors: R
authors: Jackson
authors: Liverpool Cancer Research UK Cancer Trials Unit, Liverpool Cancer Research UK Centre, University of Liverpool, Liverpool, UK.|NIHR Pancreas Biomedical Research Unit, University of Liverpool, Liverpool L69 3GA, UK.
authors: Chris
authors: C
authors: Halloran
authors: Liverpool Cancer Research UK Cancer Trials Unit, Liverpool Cancer Research UK Centre, University of Liverpool, Liverpool, UK.|NIHR Pancreas Biomedical Research Unit, University of Liverpool, Liverpool L69 3GA, UK.
authors: William
authors: W
authors: Greenhalf
authors: Liverpool Cancer Research UK Cancer Trials Unit, Liverpool Cancer Research UK Centre, University of Liverpool, Liverpool, UK.|NIHR Pancreas Biomedical Research Unit, University of Liverpool, Liverpool L69 3GA, UK.
authors: Paula
authors: P
authors: Ghaneh
authors: Liverpool Cancer Research UK Cancer Trials Unit, Liverpool Cancer Research UK Centre, University of Liverpool, Liverpool, UK.|NIHR Pancreas Biomedical Research Unit, University of Liverpool, Liverpool L69 3GA, UK.
authors: Richard F
authors: RF
authors: Lamb
authors: Department of Medicine A, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany.
authors: Markus M
authors: MM
authors: Lerch
authors: Department of Medicine A, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany.
authors: Julia
authors: J
authors: Mayerle
authors: Liverpool Cancer Research UK Cancer Trials Unit, Liverpool Cancer Research UK Centre, University of Liverpool, Liverpool, UK.|NIHR Pancreas Biomedical Research Unit, University of Liverpool, Liverpool L69 3GA, UK.
authors: Daniel
authors: D
authors: Palmer
authors: Liverpool Cancer Research UK Cancer Trials Unit, Liverpool Cancer Research UK Centre, University of Liverpool, Liverpool, UK.|NIHR Pancreas Biomedical Research Unit, University of Liverpool, Liverpool L69 3GA, UK.
authors: Trevor
authors: T
authors: Cox
authors: Liverpool Cancer Research UK Cancer Trials Unit, Liverpool Cancer Research UK Centre, University of Liverpool, Liverpool, UK.|NIHR Pancreas Biomedical Research Unit, University of Liverpool, Liverpool L69 3GA, UK.
authors: Charlotte L
authors: CL
authors: Rawcliffe
authors: Department of Surgery, University of Heidelberg, Heidelberg, Germany.
authors: Oliver
authors: O
authors: Strobel
authors: Department of Surgery, University of Heidelberg, Heidelberg, Germany.
authors: Markus W
authors: MW
authors: Büchler
authors: Liverpool Cancer Research UK Cancer Trials Unit, Liverpool Cancer Research UK Centre, University of Liverpool, Liverpool, UK.|NIHR Pancreas Biomedical Research Unit, University of Liverpool, Liverpool L69 3GA, UK.
authors: John P
authors: JP
authors: Neoptolemos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic / Q000706:statistics & numerical data; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D050177:Overweight / Q000453:epidemiology; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D007328:Insulin