Fasting Blood Glucose Levels Provide Estimate of Duration and Progression of Pancreatic Cancer Before Diagnosis.
Fasting Blood Glucose Levels Provide Estimate of Duration and Progression of Pancreatic Cancer Before Diagnosis.
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DOI：
10.1053/j.gastro.2018.04.025
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发表时间：
2018-08
期刊：
影响因子：
29.4
通讯作者：
Chari ST
中科院分区：
文献类型：
--
作者：
Sharma A;Smyrk TC;Levy MJ;Topazian MA;Chari ST
目前尚不清楚胰腺导管腺癌（PDAC）在诊断前存在多长时间。PDAC患者通常在肿瘤被确定之前发展为高血糖症和糖尿病。如果早期侵袭性PDAC与高血糖症相关，则高血糖症的持续时间应与他们患有肿瘤的时间相关。我们从2000年至2015年明尼苏达州奥姆斯特德县的医学数据库和1976年1月1日至2017年1月1日的马约诊所肿瘤登记处收集了PDAC患者的数据。我们比较了PDAC患者（病例）与年龄和性别匹配的非癌症患者（对照）的血糖谱。我们分析了在患者接受PDAC诊断（索引日期）（n=219）（队列A）之前60个月收集的空腹血糖（FBG）曲线，根据肿瘤体积和分级分层的PDAC切除患者（n=526）的FBG曲线（队列B），以及可获得长期FBG数据的PDAC切除患者（n=103）的FBG曲线（队列C）。主要结果是根据高血糖（定义为病例组FBG水平显著高于对照组（P<0.05）），在诊断前估计侵袭性PDAC的存在时间。在队列A中，在索引日期前36个月，病例组和对照组之间的平均FBG没有显著差异。在所有病例中，在PDAC诊断前36-30个月首次发现高血压，基线时有或无糖尿病，诊断时有或无切除术。FBG水平升高，直至诊断为PDAC。在队列B中，对照组与PDAC低于1.0 cc的病例的平均FBG无显著差异。与高血糖相关的最小肿瘤体积为1.1-2.0 cc; FBG水平随肿瘤体积增加而增加。FBG随肿瘤分级而变化：高分化或中等分化的肿瘤（5.8cc）产生与较小的低分化肿瘤（1.5cc）相同的FBG水平（P<0.001）。在队列C中，大、中或小体积PDAC病例的诊断前高血糖持续时间分别为36-24、24-12和12-0个月。PDAC切除术解决了高血糖症，无论肿瘤位置如何。在一项来自2个数据库的PDAC患者的病例对照研究中，我们将FBG水平与PDAC诊断时间以及肿瘤体积和分级相关联。在PDAC诊断前，患者平均高血糖持续时间为36-30个月;此信息可纳入早期检测策略中。
It is unclear how long pancreatic ductal adenocarcinomas (PDACs) are present before diagnosis. Patients with PDAC usually develop hyperglycemia and diabetes before the tumor is identified. If early invasive PDACs are associated with hyperglycemia, the duration of hyperglycemia should associate with the time that they have had the tumor. We collected data on patients with PDACs from medical databases in Olmsted County, Minnesota from 2000 through 2015 and from the Mayo Clinic’s tumor registry, from January 1, 1976 through January 1, 2017. We compared glycemic profiles of patients with PDAC (cases) compared to patients without cancer, matched for age and sex (controls). We analyzed temporal fasting blood glucose (FBG) profiles collected for 60 months before patients received a PDAC diagnosis (index date) (n=219) (cohort A), FBG profiles of patients with resected PDAC (n=526) stratified by tumor volume and grade (cohort B), and temporal FBG profiles of patients with resected PDACs from whom long-term FBG data were available (n=103) (cohort C). The primary outcome was to estimate duration of presence of invasive PDAC before its diagnosis based on hyperglycemia, defined as significantly higher (P<.05) FBG levels in cases compared to controls. In cohort A, the mean FBG did not differ significantly between cases and controls 36 months before the index date. Hyperglycemia was first noted 36–30 months before PDAC diagnosis in all cases, those with or without diabetes at baseline and those with or without resection at diagnosis. FBG level increased until diagnosis of PDAC. In cohort B, the mean FBG did not differ significantly in controls vs cases with PDACs below 1.0 cc. The smallest tumor volume associated with hyperglycemia was 1.1–2.0 cc; FBG level increased with tumor volume. FBG varied with tumor grade: well- or moderately differentiated tumors (5.8 cc) produced the same FBG levels as smaller, poorly differentiated tumors (1.5 cc) (P<.001). In cohort C, the duration of pre-diagnostic hyperglycemia for cases with large-, medium-, or small-volume PDACs was 36–24, 24–12, and 12–0 months, respectively. PDAC resection resolved hyperglycemia, regardless of tumor location. In a case–control study of patients with PDAC from 2 databases, we associated FBG level with time to PDAC diagnosis and tumor volume and grade. Patients are hyperglycemic for a mean period of 36–30 months before PDAC diagnosis; this information might be incorporated in strategies for early detection.
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影响因子：
6.4
作者：
Chien, Chun-Ru;Chen, Tony Hsiu-Hsi
通讯作者：
Chen, Tony Hsiu-Hsi
影响因子：
29.4
作者：
Aggarwal G;Ramachandran V;Javeed N;Arumugam T;Dutta S;Klee GG;Klee EW;Smyrk TC;Bamlet W;Han JJ;Rumie Vittar NB;de Andrade M;Mukhopadhyay D;Petersen GM;Fernandez-Zapico ME;Logsdon CD;Chari ST
通讯作者：
Chari ST
影响因子：
8.8
作者：
Pashayan, N.;Duffy, S. W.;Neal, D. E.
通讯作者：
Neal, D. E.
影响因子：
3.2
作者：
Sohn, TA;Yeo, CJ;Lillemoe, KD
通讯作者：
Lillemoe, KD
通过外周血基因表达谱鉴定胰腺癌相关糖尿病的新型血液生物标志物
影响因子：
9.8
作者：
Huang, Hai;Dong, Xin;Wu, Yu Lian
通讯作者：
Wu, Yu Lian