Pin Zhang1,2,3,4,5, Zhiwen Xiao1,2,3,4,5, Huaxiang Xu1,2,3,4,5, Xinzhe Zhu1,2,3,4,5, Lei Wang2,6, Dan Huang2,6, Yun Liang1,2,7, Quanxing Ni1,2,3,4,5, Jie Chen1,2,7, Xianjun Yu8,9,10,11,12, Guopei Luo13,14,15,16,17. 1. Center for Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. 2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. 3. Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China. 4. Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China. 5. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. 6. Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. 7. Department of Head & Neck tumors and Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. 8. Center for Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. yuxianjun@fudanpci.org. 9. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. yuxianjun@fudanpci.org. 10. Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China. yuxianjun@fudanpci.org. 11. Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China. yuxianjun@fudanpci.org. 12. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. yuxianjun@fudanpci.org. 13. Center for Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. luoguopei@fudnapci.org. 14. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. luoguopei@fudnapci.org. 15. Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China. luoguopei@fudnapci.org. 16. Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China. luoguopei@fudnapci.org. 17. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. luoguopei@fudnapci.org.
Abstract
BACKGROUND: Although glucose has a well-recognized protumoral role and the pancreas is a critical organ in adjusting glucose metabolism, the clinical value of hyperglycemia in pancreatic neuroendocrine neoplasms (pNENs) remains largely unidentified. METHODS: A retrospective study including 335 patients with pathologically confirmed pNENs was conducted. A baseline fasting blood glucose concentration ≥5.6 mmol/L was defined as hyperglycemia (otherwise, normal). Survival and regression analyses were performed. RESULTS: Compared with patients with normal glucose, patients with hyperglycemia (47.8%) had a higher proportion of preexisting diabetes mellitus (DM) (36.9% vs. 4.6%, p < 0.001), lymph node involvement (31.0% vs. 14.6%, p = 0.002), distant metastasis (34.4% vs. 22.9%, p = 0.019), and carbohydrate antigen 19-9 (CA19-9) ≥ 37 U/mL (16.6% vs. 7.2%, p = 0.009). Hyperglycemia was associated with CA19-9 ≥ 37 U/mL (Odds Ratio (OR) = 3.19, 95% CI: 1.11-9.17, p = 0.031), lymph node involvement (OR = 2.32, 95% CI: 1.02-5.28, p = 0.045), nonfunctional tumors (OR = 9.90, 95% CI: 2.11-46.34, p = 0.004), and preexisting diabetes (OR = 18.24, 95% CI: 4.06-81.95, p < 0.001). Hyperglycemia was an independent determinant for overall survival in the multivariate analysis (hazard ratio (HR) = 2.65, 95% CI: 1.31-5.34, p = 0.006). CONCLUSION: Hyperglycemia is an independent predictor of overall survival and is associated with preexisting DM or lymphatic metastasis in patients with pNENs. Patients with hyperglycemia and resectable pNENs may benefit from radical resection with dissection of regional lymph nodes.
BACKGROUND: Although glucose has a well-recognized protumoral role and the pancreas is a critical organ in adjusting glucose metabolism, the clinical value of hyperglycemia in pancreatic neuroendocrine neoplasms (pNENs) remains largely unidentified. METHODS: A retrospective study including 335 patients with pathologically confirmed pNENs was conducted. A baseline fasting blood glucose concentration ≥5.6 mmol/L was defined as hyperglycemia (otherwise, normal). Survival and regression analyses were performed. RESULTS: Compared with patients with normal glucose, patients with hyperglycemia (47.8%) had a higher proportion of preexisting diabetes mellitus (DM) (36.9% vs. 4.6%, p < 0.001), lymph node involvement (31.0% vs. 14.6%, p = 0.002), distant metastasis (34.4% vs. 22.9%, p = 0.019), and carbohydrate antigen 19-9 (CA19-9) ≥ 37 U/mL (16.6% vs. 7.2%, p = 0.009). Hyperglycemia was associated with CA19-9 ≥ 37 U/mL (Odds Ratio (OR) = 3.19, 95% CI: 1.11-9.17, p = 0.031), lymph node involvement (OR = 2.32, 95% CI: 1.02-5.28, p = 0.045), nonfunctional tumors (OR = 9.90, 95% CI: 2.11-46.34, p = 0.004), and preexisting diabetes (OR = 18.24, 95% CI: 4.06-81.95, p < 0.001). Hyperglycemia was an independent determinant for overall survival in the multivariate analysis (hazard ratio (HR) = 2.65, 95% CI: 1.31-5.34, p = 0.006). CONCLUSION: Hyperglycemia is an independent predictor of overall survival and is associated with preexisting DM or lymphatic metastasis in patients with pNENs. Patients with hyperglycemia and resectable pNENs may benefit from radical resection with dissection of regional lymph nodes.
Authors: Rachel E Rosenblum; Cynthia K Harris; Kiwoon Joshua Baeg; Julie A Starr; Lauren K Brais; Kristen M Stashek; Stephen C Ward; Bryson W Katona; Thomas E Clancy; Juan P Wisnivesky; Matthew H Kulke; David C Metz; Michelle Kang Kim; Jennifer A Chan Journal: Pancreas Date: 2020-02 Impact factor: 3.327
Authors: T Feola; G Puliani; F Sesti; R Modica; R Centello; R Minotta; G Cannavale; S Di Meglio; V Di Vito; R Lauretta; M Appetecchia; A Colao; A Lenzi; A M Isidori; A Faggiano; E Giannetta Journal: J Endocrinol Invest Date: 2022-01-18 Impact factor: 4.256