A prospective pancreatographic study of the prevalence of pancreatic carcinoma in patients with diabetes mellitus
A prospective pancreatographic study of the prevalence of pancreatic carcinoma in patients with diabetes mellitus
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DOI：
10.1002/cncr.10493
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发表时间：
2002-05-01
期刊：
影响因子：
6.2
通讯作者：
Nakamura, Y
中科院分区：
文献类型：
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作者：
Ogawa, Y;Tanaka, M;Nakamura, Y
背景糖尿病和胰腺癌之间的相关性是有据可查的，但尚未建立有效选择糖尿病患者中高危人群的标准。87例患者前瞻性地从门诊糖尿病患者中选择，并根据作者的原始标准进行内窥镜逆行胰管造影（ERP），包括55岁以后糖尿病发病，糖尿病恶化或体重减轻，尽管严格的药物控制，血清淀粉酶和/或CA 19 -9水平升高，以及常规超声检查的胰胆管异常。根据糖尿病发病至ERP的时间将患者分为两组：A组为近期发病糖尿病患者（3年内），B组为糖尿病病程> 3年。共入组86例患者（不包括1例既往接受过Billroth-2胃切除术的ERP不成功患者）。男33例，女53例，年龄40-90岁，平均年龄65.1岁。ERP显示胰腺癌，尽管所有患者均为晚期疾病，但其发生率极高，为7.0%（86例患者中有6例），无严重并发症。A组胰腺癌的患病率（13.9%; 5/36例患者）显著高于B组（2.0%; 1/50例患者; P = 0.0442）。对49例患者行留置球囊导管的ERP及随后的胰液取样，其中1例胰尾癌患者细胞学检查阳性，而测定胰液中癌胚抗原和CA 19 -9水平对胰腺癌的诊断没有帮助。糖尿病高危患者的选择性ERP并不能导致胰腺癌的早期诊断，尽管这项研究表明糖尿病发病后3年的时间是至关重要的。在糖尿病患者的这一时期，采用作者的标准进行更积极的诊断方法可能有助于胰腺癌的早期诊断。(C)2002年美国癌症协会。
BACKGROUND. The correlation between diabetes mellitus and pancreatic carcinoma is well documented, but no criteria have been established for the efficient selection of a high-risk group among patients with diabetes mellitus.METHODS. Eighty-seven patients were selected prospectively from outpatients with diabetes and underwent endoscopic retrograde pancreatography (ERP) according to the authors' original criteria, including the onset of diabetes after age 55 years, deterioration of diabetes or loss of body weight despite strict medical control, elevation of serum amylase and/or CA19-9 levels, and pancreatobiliary abnormalities oil routine ultrasonography. The patients were divided into two groups according to the time from the onset of diabetes to ERP: Patients in Group A had recent-onset diabetes (within 3 years), and Group B patients had diabetes for > 3 years.RESULTS. A total of 86 patients (excluding 1 patient with unsuccessful ERP who had undergone previous Billroth-2 gastrectomy) were enrolled. There were 33 males and 53 females, age 40-90 years, with a mean age of 65.1 years. ERP demonstrated pancreatic carcinoma, although it was advanced disease in all patients, at an extremely high rate of 7.0% (6 of 86 patients) with no serious complications. The prevalence of pancreatic carcinoma in Group A (13.9%; 5 of 36 patients) was significantly greater compared with Group B (2.0%; 1 of 50 patients; P = 0.0442). ERP with an indwelling balloon catheter and subsequent pancreatic juice sampling was performed in 49 patients, yielding positive cytology in 1 patient with pancreatic tail carcinoma, whereas measurements of carcinoembryonic antigen and CA19-9 levels in pancreatic juice were of no use in the diagnosis of pancreatic carcinoma.CONCLUSIONS. Selective ERP in patients with diabetes who were at high risk did not lead to the early diagnosis of pancreatic carcinoma, although this study showed that the 3-year period after the onset of diabetes was critical. A more aggressive diagnostic approach within this period in diabetic patients with the authors' criteria may contribute to the earlier diagnosis of pancreatic carcinoma. (C) 2002 American Cancer Society.