胰岛素依赖是缩短胰腺神经内分泌肿瘤癌症特异性生存期的预测因素:美国神经内分泌研究小组的一项多机构研究

Muhammad Bilal Mirza, Jordan Baechle, Paula Marincola Smith, Danish Ali, Mary Dillhoff, George Poultsides, Flavio Rocha, Clifford Cho, Emily Winslow, Ryan Fields, Shishir Maithel, Kamran Idrees
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摘要

简介胰腺肿瘤网(PNET)是源自胰岛细胞的罕见胰腺恶性肿瘤,与糖尿病(DM)并发率高,存活率较低。然而,尚未有研究明确胰岛素依赖型(IDDM)和非胰岛素依赖型(NIDDM)对不良肿瘤预后的影响。研究方法利用美国神经内分泌肿瘤研究小组数据库(1999-2016 年),我们对接受 PNET 初级手术切除的成年患者进行了一项回顾性队列研究。根据术前诊断将患者分为非糖尿病组、NIDDM 组和 IDDM 组。我们使用 Kaplan-Meier 法和对数秩检验来研究癌症特异性生存率(CSS)。采用 Cox 比例危险度模型评估 IDDM 对 CSS 的影响。结果:在纳入分析的 1,122 例患者中,870 例(77%)为非 IDDM 患者,168 例(15%)为 NIDDM 患者,84 例(8%)为 IDDM 患者。各组患者的肿瘤分期和分级相似。但是,他们在性别、体重指数、年龄、ASA 分级、肿瘤位置、术前 HbA1c 和血清葡萄糖方面存在差异(P 值为 0.05)。与非 IDDM 患者相比,IDDM 患者的 5 年 CSS 明显降低(CSS:IDDM 85%、NIDDM 94%、非 IDDM 93%、NIDDM + 非 IDDM 93%;P <0.01)。在多变量分析中,IDDM 与较差的 CSS 独立相关(HR 2.27,95% 置信区间 1.15-4.45,P=0.02)。结论与 NIDDM 或无 DM 的 PNET 患者相比,胰岛素依赖与手术切除后 PNET 患者的癌症特异性生存率较低有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Insulin-dependence as a Predictor of Shortened Cancer-specific Survival in Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study from the United States Neuroendocrine Study Group
Introduction: PNETs are rare pancreatic malignancies originating from islet cells and exhibit a strong co-occurrence with Diabetes Mellitus (DM), associated with worse survival outcomes. However, studies have yet to delineate the impact of insulin dependent (IDDM) and non -insulin dependent (NIDDM) on poor oncological outcomes. Methods: Utilizing the U.S. Neuroendocrine Tumor Study Group database (1999-2016), we performed a retrospective cohort study of adult patients who underwent primary surgical resection of PNETs. Patients were categorized based on preoperative diagnosis into non-DM, NIDDM, and IDDM cohorts. We used the Kaplan-Meier method and log-rank test to study cancer-specific survival (CSS). Cox proportional Hazards models were used to assess the impact of IDDM on CSS. Results: Of the 1,122 patients included in the analysis, 870 (77%) were non-DM, 168 (15%) were NIDDM, and 84 (8%) were IDDM. The groups were similar in tumor stage and grade. However, they differed in sex, BMI, age, ASA class, tumor location, preoperative HbA1c and serum glucose (p-value <0.05). Patients with IDDM had significantly decreased 5-year CSS compared to patients without IDDM (CSS: IDDM 85%, NIDDM 94%, non-DM 93%, NIDDM + non-DM 93%; P <0.01). On multivariate analysis, IDDM was independently associated with worse CSS (HR 2.27, 95% Confidence Interval 1.15-4.45, P=0.02). Conclusion: Insulin dependence is associated with worse cancer-specific survival in PNET patients following surgical resection compared to PNET patients with NIDDM or without DM.
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