Impact of Perioperative Hemoglobin A1c Levels on Survival Outcomes of Patients With Pancreatic Cancer: A Retrospective Study.

Annals of surgery open : perspectives of surgical history, education, and clinical approaches Pub Date : 2025-07-11 eCollection Date: 2025-09-01 DOI:10.1097/AS9.0000000000000597

Hidemasa Kubo, Katsuhisa Ohgi, Shimpei Otsuka, Yuta Okawa, Ryo Ashida, Mihoko Yamada, Yoshiyasu Kato, Hideyuki Dei, Katsuhiko Uesaka, Akifumi Notsu, Teiichi Sugiura

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Abstract

Objective: This study aimed to clarify the association between perioperative hemoglobin A1c (HbA1c) levels and survival outcomes in pancreatic cancer (PC) patients.

Background: Diabetes mellitus is frequently associated with PC and may affect survival outcomes.

Methods: We retrospectively analyzed 569 patients who underwent pancreatectomy for PC with available preoperative HbA1c (HbA1c-pre) data (2002-2018). A subgroup analysis included 318 patients with HbA1c measured 1 year postsurgery (HbA1c-1Y).

Results: Optimal cutoff values were 9.0 for HbA1c-pre and 10.0 for HbA1c-1Y. Patients with HbA1c-pre ≥9.0 had worse relapse-free survival (RFS; median, 11.8 vs. 16.3 months, P = 0.002) and overall survival (OS; median, 20.3 vs. 32.9 months, P < 0.001) than those with HbA1c-pre <9.0. Multivariate analysis identified HbA1c-pre ≥9.0 as an independent prognostic factor for RFS (hazard ratio: 1.39, P = 0.029) and OS (hazard ratio: 1.51, P = 0.010). Patients with HbA1c-1Y ≥10.0 had worse RFS (median, 11.3 vs. 25.0 months, P < 0.001) and OS (median, 22.2 vs. 52.8 months, P = 0.002) than those with HbA1c-1Y <10.0. HbA1c-1Y ≥10.0 was associated with distal pancreatectomy (DP) and recurrence within 1-year postsurgery. HbA1c levels decreased after pancreatoduodenectomy (PD; HbA1c-pre 6.4 vs. HbA1c-1Y 6.0, P < 0.001), although HbA1c levels were increased after DP (6.5 vs. 7.0, P = 0.041). Patients with HbA1c-1Y ≥10.0 had poor survival outcomes regardless of the surgical procedure (DP: RFS, P < 0.001; OS, P = 0.006) (PD: RFS, P = 0.006; OS, P = 0.001).

Conclusions: HbA1c-pre ≥9.0 and HbA1c-1Y ≥10.0 were prognostic factors in PC. Postoperative follow-up for diabetes mellitus is important, particularly following DP.

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围手术期血红蛋白A1c水平对胰腺癌患者生存结果的影响：一项回顾性研究

目的：本研究旨在阐明胰腺癌（PC）患者围手术期血红蛋白A1c （HbA1c）水平与生存结局之间的关系。背景：糖尿病常与PC相关，并可能影响生存结果。方法：回顾性分析569例接受胰腺切除术的PC患者，术前HbA1c （HbA1c-pre）数据（2002-2018）。亚组分析包括318例术后1年HbA1c患者（HbA1c- 1y）。结果：HbA1c-pre和HbA1c-1Y的最佳临界值分别为9.0和10.0。HbA1c-pre≥9.0的患者无复发生存期（RFS；中位数，11.8个月vs. 16.3个月，P = 0.002）和总生存期（OS；中位数，20.3个月vs. 32.9个月，P < 0.001）均低于HbA1c-pre患者（风险比：1.51,P = 0.010）。HbA1c- 1y≥10.0的患者的RFS（中位数，11.3个月vs. 25.0个月，P < 0.001）和OS（中位数，22.2个月vs. 52.8个月，P = 0.002）较HbA1c- 1y患者更差，尽管DP后HbA1c水平升高（6.5 vs. 7.0, P = 0.041）。无论手术方式如何，HbA1c-1Y≥10.0的患者生存结果较差（DP: RFS, P < 0.001； OS, P = 0.006）（PD: RFS, P = 0.006； OS, P = 0.001）。结论：HbA1c-pre≥9.0、HbA1c-1Y≥10.0是影响PC预后的因素。糖尿病的术后随访是很重要的，尤其是DP患者。

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Annals of surgery open : perspectives of surgical history, education, and clinical approaches

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