Yitao Gong1,2,3,4, Zhiyao Fan1,2,3,4, Pin Zhang1,2,3,4, Yunzhen Qian1,2,3,4, Qiuyi Huang1,2,3,4, Shengming Deng1,2,3,4, Guopei Luo1,2,3,4, He Cheng1,2,3,4, Kaizhou Jin1,2,3,4, Quanxing Ni1,2,3,4, Xianjun Yu5,6,7,8, Chen Liu9,10,11,12. 1. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 200032, Shanghai, China. 2. Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China. 3. Shanghai Pancreatic Cancer Institute, 200032, Shanghai, China. 4. Pancreatic Cancer Institute, Fudan University, 200032, Shanghai, China. 5. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 200032, Shanghai, China. yuxianjun@fudanpci.org. 6. Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China. yuxianjun@fudanpci.org. 7. Shanghai Pancreatic Cancer Institute, 200032, Shanghai, China. yuxianjun@fudanpci.org. 8. Pancreatic Cancer Institute, Fudan University, 200032, Shanghai, China. yuxianjun@fudanpci.org. 9. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 200032, Shanghai, China. liuchen@fudanpci.org. 10. Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China. liuchen@fudanpci.org. 11. Shanghai Pancreatic Cancer Institute, 200032, Shanghai, China. liuchen@fudanpci.org. 12. Pancreatic Cancer Institute, Fudan University, 200032, Shanghai, China. liuchen@fudanpci.org.
Abstract
BACKGROUND: Hyperglycaemia has been indicated as a pro-tumoural factor; however, the prognostic role of diabetes mellitus (DM) in pancreatic neuroendocrine tumours (panNETs) remains ambiguous, partly due to the effects of anti-diabetic drugs. We hypothesise that the blood sugar level per se affects the outcome of panNETs, and thus, we investigated the prognostic significance of the fasting blood glucose (FBG) level in resected panNET patients with no pre-existing DM. METHODS: A retrospective cohort study comprising 201 patients with radically resected non-functional panNETs was conducted. A total of 164 patients without pre-existing DM were further studied. An FBG level greater than 5.6 mmol/L was defined as high (otherwise, normal). Survival was evaluated using Kaplan-Meier methods and log-rank tests. Multivariate analyses for survival were performed using the Cox regression model. RESULTS: High FBG levels were significantly associated with poor overall survival (OS; p = 0.019) and recurrence-free survival (RFS; p = 0.011) in resected patients with panNET who had no pre-existing DM. The multivariable-adjusted hazard ratios (HRs) for mortality and recurrence comparing patients with high and normal FBG levels were 12.19 (95% confidence interval (CI) = 1.15-128.78, p = 0.038) and 2.43 (95% CI = 1.03-5.72, p = 0.042), respectively. CONCLUSION: A pre-operative FBG level greater than 5.6 mmol/L is associated with poor OS and RFS metastasis for patients with panNET who undergo radical surgical resection.
BACKGROUND: Hyperglycaemia has been indicated as a pro-tumoural factor; however, the prognostic role of diabetes mellitus (DM) in pancreatic neuroendocrine tumours (panNETs) remains ambiguous, partly due to the effects of anti-diabetic drugs. We hypothesise that the blood sugar level per se affects the outcome of panNETs, and thus, we investigated the prognostic significance of the fasting blood glucose (FBG) level in resected panNET patients with no pre-existing DM. METHODS: A retrospective cohort study comprising 201 patients with radically resected non-functional panNETs was conducted. A total of 164 patients without pre-existing DM were further studied. An FBG level greater than 5.6 mmol/L was defined as high (otherwise, normal). Survival was evaluated using Kaplan-Meier methods and log-rank tests. Multivariate analyses for survival were performed using the Cox regression model. RESULTS: High FBG levels were significantly associated with poor overall survival (OS; p = 0.019) and recurrence-free survival (RFS; p = 0.011) in resected patients with panNET who had no pre-existing DM. The multivariable-adjusted hazard ratios (HRs) for mortality and recurrence comparing patients with high and normal FBG levels were 12.19 (95% confidence interval (CI) = 1.15-128.78, p = 0.038) and 2.43 (95% CI = 1.03-5.72, p = 0.042), respectively. CONCLUSION: A pre-operative FBG level greater than 5.6 mmol/L is associated with poor OS and RFS metastasis for patients with panNET who undergo radical surgical resection.
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