Pancreatic Cancer and Diabetes Mellitus.
Pancreatic Cancer and Diabetes Mellitus.
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DOI：
10.1007/s11938-018-0197-8
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发表时间：
2018-12
期刊：
影响因子：
--
通讯作者：
Chari ST
中科院分区：
文献类型：
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作者：
Sharma A;Chari ST
胰腺导管腺癌（PDAC）与糖尿病（DM）的关系较为复杂.我们回顾了最近的医学文献，抗糖尿病药物对PDAC风险和生存率的影响;糖尿病中PDAC的风险;糖尿病在PDAC早期检测中的作用。研究报告说，虽然一些抗糖尿病药物（例如，二甲双胍）可能降低PDAC的风险，其他（胰岛素、磺脲类和肠促胰岛素为基础的治疗）可能增加风险。然而，这些观察结果可能会受到原病理偏见。二甲双胍的抗肿瘤活性可能会影响PDAC的总生存率，但由于方法的异质性，流行病学报告在很大程度上不一致。有一致的数据支持DM和PDAC之间的关联，与DM持续时间呈反比关系。新发DM的老年受试者是唯一已知的PDAC高风险组，使用该组进行早期检测的策略导致了定义极高风险PDAC组的临床风险预测模型的开发。抗糖尿病药物在PDAC风险改善或生存中的作用存在争议。随着使用风险分层模型成功区分2型DM和PDAC-DM的努力，有机会启动筛查方案，以在DM受试者的子集中早期检测PDAC。
The relationship between pancreatic ductal adenocarcinoma (PDAC) and diabetes mellitus (DM) is complex. We reviewed the recent medical literature regarding the effect of anti-diabetic medication on PDAC risk and survival; risk of PDAC in DM; and role of DM in early detection of PDAC. Studies report that while some anti-diabetic medications (e.g., metformin) may decrease the risk of PDAC, others (insulin, sulfonylureas and incretin-based therapies) may increase the risk. However, these observations may be subject to protopathic biases. Metformin’s anti-tumor activity may have influence overall survival of PDAC, but epidemiological reports have largely been inconsistent to defend these findings due to heterogeneous methodologies. There is congruent data to support the association between DM and PDAC, with an inverse relationship to DM duration. Older subjects with new-onset DM are the only known high-risk group for PDAC and strategy using this group for early detection has led to development of clinical risk prediction models that defines a very high-risk PDAC group. Role of anti-diabetic medication in PDAC risk modification or survival is controversial. With successful efforts to distinguish type 2-DM from PDAC-DM using risk stratifying models, there is an opportunity to initiate screening protocols for early detection of PDAC in a sub-set of DM subjects.