Resectability of presymptomatic pancreatic cancer and its relationship to onset of diabetes: A retrospective review of CT scans and fasting glucose values prior to diagnosis
Resectability of presymptomatic pancreatic cancer and its relationship to onset of diabetes: A retrospective review of CT scans and fasting glucose values prior to diagnosis
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DOI：
10.1111/j.1572-0241.2007.01480.x
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发表时间：
2007-10-01
影响因子：
9.8
通讯作者：
Chari, Suresh T.
中科院分区：
文献类型：
--
作者：
Pelaez-Luna, Mario;Takahashi, Naoki;Chari, Suresh T.
背景：胰腺癌从可切除疾病发展到不可切除疾病的时间线尚不清楚。新发糖尿病常发生在胰腺癌中。目前尚不清楚癌症在糖尿病发作时是否可以切除。我们(A)在临床诊断前通过腹部CT扫描来确定胰腺癌的可切除性，以及(B)可切除性与糖尿病发病的相关性。方法：回顾所有在胰腺癌诊断时或在胰腺癌诊断前所做的CT扫描，将胰腺病变分为正常、潜在可切除或不能切除的胰腺癌。有18名患者在诊断时和诊断前获得了空腹血糖值。记录糖尿病的发病日期和发病至癌症诊断的间隔时间。结果：30例患者符合纳入标准。在诊断之前，28名患者在癌症诊断前平均18个月(范围1-41)进行了38次CT扫描。在癌症诊断时，只有7/30的患者可以接受切缘阴性的手术切除。诊断前6个月做的CT扫描显示胰腺正常(N=20)或可切除的肿块(N=6)；没有不能切除的癌症。糖尿病发病到胰腺癌诊断的时间间隔平均为10个月(5-29个月)。在糖尿病发病时，3例患者胰腺正常，6例可切除，4例胰腺癌不能切除。结论：在临床诊断前6个月行CT扫描时，胰腺癌常常是无法发现或可切除的。在糖尿病发作时，胰腺癌通常是可以切除的。
BACKGROUND: The timeline of progression of pancreatic cancer from resectable to unresectable disease is unknown. New-onset diabetes often occurs in pancreatic cancer. It is unclear if the cancer is resectable at the onset of diabetes. We (a) determined the resectability of pancreatic cancer on abdominal CT scans done prior to clinical diagnosis and (b) correlated resectability with onset of diabetes.METHODS: All CT scans done at diagnosis or before pancreatic cancer diagnosis were reviewed and pancreatic changes classified as normal, potentially resectable, or unresectable pancreatic cancer. Fasting blood glucose values obtained at and prior to diagnosis were available in 18 patients. The date of onset of diabetes and the interval between onset of diabetes and diagnosis of cancer were noted.RESULTS: Thirty patients fulfilled inclusion criteria. Prior to diagnosis, 28 patients had 38 CT scans done at a median of 18 months (range 1-41) before cancer diagnosis. At cancer diagnosis, only 7/30 patients could undergo margin-negative surgical resection. CT scans done >= 6 months prior to diagnosis showed either a normal pancreas (N = 20) or a resectable mass (N = 6); none had unresectable cancer. The mean interval between onset of diabetes and diagnosis of pancreatic cancer was 10 months (range 5-29 months). At the onset of diabetes, 3 patients had normal pancreas, 6 had resectable, and 4 had unresectable pancreatic cancer.CONCLUSIONS: Pancreatic cancer is frequently undetectable or resectable on CT scans done >= 6 months prior to clinical diagnosis. At onset of diabetes, pancreatic cancers are generally resectable.