Abstract
Background
Diabetes mellitus is associated with increased risk of pancreatic cancer and impaired
postresection survival. For pancreatic neuroendocrine neoplasms, no evidence is available
for a similar effect of diabetes mellitus. The aim of this study was to evaluate the
glycemic profile in patients with pancreatic neuroendocrine neoplasms and to assess
the potential impact of glycemic control on the pathology and long-term outcomes in
patients undergoing resection of pancreatic neuroendocrine neoplasms.
Methods
Pancreatic resections from 2001 to 2017 for pancreatic neuroendocrine neoplasms were
analyzed from prospective databases. Blood glucose and HbA1c levels were collected
from preoperative tests. Preoperative dysglycemia was defined as a blood glucose ≥140
mg% and/or HbA1c ≥6.5%. Uni- and multivariate analyses were performed according to
the presence of perioperative dysglycemia. Survival analyses were performed by Kaplan-Meier
curves and Cox-proportional hazards method.
Results
Four hundred and seventeen patients were analyzed. Medical history was positive for
diabetes mellitus in 88 (21.1%) patients. Blood glucose evaluation identified 30 additional
patients without a prior diagnosis of diabetes mellitus who had preoperative dysglycemia.
No differences regarding pathologic characteristics or outcomes were detected between
diabetics and non-diabetics. Conversely, patients with dysglycemia had greater rates
of metastasis (16.8% vs 27.4%; P = .027) as well as vascular, perineural, and lympho-vascular involvement than those
with normal blood glucose (89.2% vs 57.4%; P < .001, 90.0% vs 65.1%; P = .046, and 89.3% vs 61.3; P = .006, respectively). Preoperative dysglycemia was associated with impaired overall
survival (hazard ratio = 1.57 [1.01–2.46]) and recurrence-free survival (hazard ratio =
1.78 [1.01–3.12]). By multivariate analysis, preoperative dysglycemia was independently
associated with recurrence-free survival (hazard ratio 2.32 [1.29–4.17]), together
with lymph-node involvement (hazard ratio = 2.01 [1.14–3.57]) and metastatic disease
(hazard ratio = 5.10 [2.73–9.55]).
Conclusion
Preoperative dysglycemia, but not diabetes mellitus per se, is associated with advanced
disease and impaired long-term outcomes in patients undergoing resection for a pancreatic
neuroendocrine neoplasm. For those patients, closer surveillance and strict glycemic
control are warranted.
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Article info
Publication history
Published online: December 27, 2019
Accepted:
November 3,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
