Effect of Diabetes on Survival after Resection of Pancreatic Adenocarcinoma. A Prospective, Observational Study.
OBJECTIVE
To investigate the effect of diabetes mellitus (DM) on disease-free and overall post-resection survival of patients with pancreatic ductal adenocarcinoma (PDAC).


METHODS
Prospective observational study on patients admitted for pancreatic disease from January 2008 to October 2012. DM was classified as recent-onset (<48 months before PDAC diagnosis), longstanding (≥48 months before PDAC) or new onset (after surgery).


RESULTS
Of 296 patients, 140 had a diagnosis of DM prior to surgery (26 longstanding, 99 recent-onset, 15 with unknown duration). Median follow-up time was 5.4 ± 0.22 years. Patients with recent onset DM had poorer postoperative survival than patients without DM: disease-free survival and overall survival were 1.14±0.13 years and 1.52±0.12 years in recent onset DM, versus 1.3±0.15 years and 1.87±0.15 years in non-diabetic patients (p = 0.013 and p = 0.025, respectively). Longstanding DM and postoperative new onset DM had no impact on prognosis. Compared to cases without DM, patients with recent onset DM were more likely to have residual disease after surgery and to develop liver metastases during follow-up. Multivariate analysis confirmed recent onset DM was independently associated with PDAC relapse (hazard ratio 1.45 [1.06-1.99]).


CONCLUSIONS
Preoperative recent onset DM has an impact on survival after the resection of PDAC.
Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center; IRCCS San Raffaele Scientific Institute, Milan, Italy.
Gianpaolo
G
Balzano
San Raffaele Diabetes Research Institute (SR-DRI), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Erica
E
Dugnani
San Raffaele Diabetes Research Institute (SR-DRI), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Alessandra
A
Gandolfi
San Raffaele Diabetes Research Institute (SR-DRI), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Marina
M
Scavini
San Raffaele Diabetes Research Institute (SR-DRI), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Valentina
V
Pasquale
Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center; IRCCS San Raffaele Scientific Institute, Milan, Italy.
Francesca
F
Aleotti
San Raffaele Diabetes Research Institute (SR-DRI), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Daniela
D
Liberati
Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Gaetano
G
Di Terlizzi
Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Giovanna
G
Petrella
Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Michele
M
Reni
Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
Claudio
C
Doglioni
San Raffaele Diabetes Research Institute (SR-DRI), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Emanuele
E
Bosi
Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center; IRCCS San Raffaele Scientific Institute, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
Massimo
M
Falconi
San Raffaele Diabetes Research Institute (SR-DRI), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Lorenzo
http://orcid.org/0000-0002-2172-2198
L
Piemonti
D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000368:Aged; D003920:Diabetes Mellitus / Q000401:mortality* / Q000503:physiopathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors