胰腺癌患者术前血糖水平与临床病理特征的相关分析
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摘要
目的回顾分析胰腺癌患者的临床病例资料,探讨术前血糖水平与胰腺癌患者预后的相关关系。方法收集自2015年1月至2016年9月收治于西安交通大学第一附属医院的267例胰腺癌患者的临床资料,对胰腺癌的病理特征进行分析总结,并对术前血糖水平与胰腺癌的临床病理特征进行相关性分析。结果 267例患者中共110例被纳入研究,其中男性68例(61.82%),女性42例(38.18%),年龄(41～84)岁,平均年龄(61.34±10.33)岁。术前空腹血糖升高者(>6.1 mmol/L)共74例(67.27%),正常者36例(32.73%);术前CEA显著升高者57例(51.81%); CA125升高者33例(30.0%),CA199升高者83例(75.45%)。110例患者中,肿瘤大小<3 cm的56例(50.91%),≥3 cm的54例(49.09%);肿瘤位于胰头部73例(66.36%),位于体尾部37例(33.64%);病理学类型:腺癌占92.73%,鳞癌占2.73%,腺鳞癌占2.73%,黏液性囊腺癌占1.81%;病理学分级:高分化6例,中分化65例,中-低分化12例,低分化27例;TNM分期:ⅠA期2例,ⅠB期13例,ⅡA期27例,ⅡB期20例,Ⅲ期15例,Ⅳ期33例;19例患者伴有淋巴结转移,22例伴有远处转移,22例伴有神经浸润。110例患者均得到有效随访,随访时间为(1.0～14.0)月,平均随访时间为(4.6±3.8)月,截至末次随访,共14例患者复发或转移;正常血糖组胰腺癌患者的中位生存期为10个月,而高血糖组胰腺癌患者的中位生存期仅为4个月。术前血糖水平与胰腺癌患者的预后、原发肿瘤大小、TNM分期、远处转移、淋巴结转移及神经浸润等临床病理特征密切相关。结论术前高血糖水平是胰腺癌患者不良预后的危险因素。
Objective To analyze the clinicopathologic characteristics of pancreatic cancer patients and explore the relationship between preoperative blood glucose level and prognosis of pancreatic cancer. Methods The clinical data of 267 patients treated in The First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to September 2016 were collected and retrospectively analyzed. We also studied the correlation between preoperative blood glucose level and clinicopathologic characteristics of pancreatic cancer. Results For the study we selected 110 patients(68 males and 42 females) aged between 41 and 84 years with the mean age of(61.34±10.33) years. Among them, 74(67.27%) of them had preoperative blood glucose level(>6.1 mmol/L) higher than normal level. In addition, 57 patients(51.81%) and 33 patients(30.0%) had CEA level and CA125 level significantly higher than normal and 83 patients(75.45%) had higher CA199 level. There were 56 patients(50.91%)with tumor size over 3 cm and73(66.36%)with the tumor located in the head of pancreas.There were 92.73% of patients diagnosed with adenocarcinoma,2.73% with squamous carcinoma,2.73% with adenosquamous carcinoma and 1.81% with mucinous cystadenocarcinoma.As for pathological grading,there were 6 cases diagnosed with highly differentiated tumors,65 cases moderate,12 moderate to low differentiated,and 27 lowly differentiated tumors.For clinical stage,2,13,27,20,15 and 33 patients were detected in stageⅠA,ⅢB,ⅡA,ⅡB,Ⅲ andⅣ,respectively.In addition,there were 19 patients detected with lymph node metastases,22 with distal metastases and 22 with neural invasion.All the 110 patients were followed up effectively,with the average follow-up duration of(4.6±3.8)months.Until the last time we followed up all the patients,we found the tumor relapsed in 14 patients.The median survival time of patients with normal blood glucose was 10 months,while it was only 4 months in patients with high blood glucose.Preoperative blood glucose level was closely related with the patientsprognosis and tumor size,TNM stage,distal metastasis,lymph node metastasis,and neural invasion.Conclusion High blood glucose level is one of the risk factors for the poor prognosis of pancreatic cancer.
Objective To analyze the clinicopathologic characteristics of pancreatic cancer patients and explore the relationship between preoperative blood glucose level and prognosis of pancreatic cancer. Methods The clinical data of 267 patients treated in The First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to September 2016 were collected and retrospectively analyzed. We also studied the correlation between preoperative blood glucose level and clinicopathologic characteristics of pancreatic cancer. Results For the study we selected 110 patients(68 males and 42 females) aged between 41 and 84 years with the mean age of(61.34±10.33) years. Among them, 74(67.27%) of them had preoperative blood glucose level(>6.1 mmol/L) higher than normal level. In addition, 57 patients(51.81%) and 33 patients(30.0%) had CEA level and CA125 level significantly higher than normal and 83 patients(75.45%) had higher CA199 level. There were 56 patients(50.91%)with tumor size over 3 cm and73(66.36%)with the tumor located in the head of pancreas.There were 92.73% of patients diagnosed with adenocarcinoma,2.73% with squamous carcinoma,2.73% with adenosquamous carcinoma and 1.81% with mucinous cystadenocarcinoma.As for pathological grading,there were 6 cases diagnosed with highly differentiated tumors,65 cases moderate,12 moderate to low differentiated,and 27 lowly differentiated tumors.For clinical stage,2,13,27,20,15 and 33 patients were detected in stageⅠA,ⅢB,ⅡA,ⅡB,Ⅲ andⅣ,respectively.In addition,there were 19 patients detected with lymph node metastases,22 with distal metastases and 22 with neural invasion.All the 110 patients were followed up effectively,with the average follow-up duration of(4.6±3.8)months.Until the last time we followed up all the patients,we found the tumor relapsed in 14 patients.The median survival time of patients with normal blood glucose was 10 months,while it was only 4 months in patients with high blood glucose.Preoperative blood glucose level was closely related with the patientsprognosis and tumor size,TNM stage,distal metastasis,lymph node metastasis,and neural invasion.Conclusion High blood glucose level is one of the risk factors for the poor prognosis of pancreatic cancer.
引文
[1] SIEGEL RL,MILLER KD,JEMAL A.Cancer statistics,2018[J].CA Cancer J Clin,2018,68(1):7-30.
[2] RAHIB L,SMITH BD,AIZENBERG R,et al.Projecting cancer incidence and deaths to 2030:The unexpected burden of thyroid,liver,and pancreas cancers in the United States[J].Cancer Res,2014,74(11):2913-2921.
[3] RAHN S,ZIMMERMANN V,VIOL F,et al.Diabetes as risk factor for pancreatic cancer:Hyperglycemia promotes epithelial-mesenchymal-transition and stem cell properties in pancreatic ductal epithelial cells[J].Cancer Lett,2018,415:129-150.
[4] FITZMAURICE C,DICKER D,PAIN A,et al.The global burden of cancer 2013[J].JAMA Oncol,2015,1(4):505-527.
[5] LIN QJ,YANG F,JIN C,et al.Current status and progress of pancreatic cancer in China[J].World J Gastroenterol,2015,21(26):7988-8003.
[6] 陈万青,郑荣寿,张思维.中国恶性肿瘤的动态变化[J].科技导报,2014,32(26):65-71.
[7] 马少军,屈振亮,孔棣,等.胰腺癌流行病学及诊断研究进展[J].中国中西医结合外科杂志,2015,21(1):87-92.
[8] 王理伟,陈栋晖,李琦,等.胰腺癌综合诊治中国专家共识(2014年版)[J].临床肿瘤学杂志,2014,19(4):358-370.
[9] MAISONNEUVE P,LOWENFELS AB.Risk factors for pancreatic cancer:A summary review of meta-analytical studies[J].Int J Epidemiol,2015,44(1):186-198.
[10] LI D.Diabetes and pancreatic cancer[J].Mol Carcinog,2012,51(1):64-74.
[11] DUAN W,SHEN X,LEI J,et al.Hyperglycemia,a neglected factor during cancer progression[J].Biomed Res Int,2014,2014:461917.
[12] 黎韡,徐勤鸿,马清涌.高糖状态对胰腺癌细胞氧化应激水平的促进作用[J].西安交通大学学报(医学版),2016,37(6):789-794.
[13] LI W,ZHANG L,CHEN X,et al.Hyperglycemia promotes the epithelial-mesenchymal transition of pancreatic cancer via hydrogen peroxide[J].Oxid Med Cell Longev,2016,2016:5190314.
[14] LI J,MA Q.Hyperglycemia promotes the perineural invasion in pancreatic cancer[J].Med Hypotheses,2008,71(3):386-389.
[15] HAN L,MA Q,LI J,et al.High glucose promotes pancreatic cancer cell proliferation via the induction of EGF expression and transactivation of EGFR[J].PLoS One,2011,6(11):e27074.
[16] LIU H,MA Q,LI J.High glucose promotes cell proliferation and enhances GDNF and RET expression in pancreatic cancer cells[J].Mol Cell Biochem,2011,347(1-2):95-101.
[2] RAHIB L,SMITH BD,AIZENBERG R,et al.Projecting cancer incidence and deaths to 2030:The unexpected burden of thyroid,liver,and pancreas cancers in the United States[J].Cancer Res,2014,74(11):2913-2921.
[3] RAHN S,ZIMMERMANN V,VIOL F,et al.Diabetes as risk factor for pancreatic cancer:Hyperglycemia promotes epithelial-mesenchymal-transition and stem cell properties in pancreatic ductal epithelial cells[J].Cancer Lett,2018,415:129-150.
[4] FITZMAURICE C,DICKER D,PAIN A,et al.The global burden of cancer 2013[J].JAMA Oncol,2015,1(4):505-527.
[5] LIN QJ,YANG F,JIN C,et al.Current status and progress of pancreatic cancer in China[J].World J Gastroenterol,2015,21(26):7988-8003.
[6] 陈万青,郑荣寿,张思维.中国恶性肿瘤的动态变化[J].科技导报,2014,32(26):65-71.
[7] 马少军,屈振亮,孔棣,等.胰腺癌流行病学及诊断研究进展[J].中国中西医结合外科杂志,2015,21(1):87-92.
[8] 王理伟,陈栋晖,李琦,等.胰腺癌综合诊治中国专家共识(2014年版)[J].临床肿瘤学杂志,2014,19(4):358-370.
[9] MAISONNEUVE P,LOWENFELS AB.Risk factors for pancreatic cancer:A summary review of meta-analytical studies[J].Int J Epidemiol,2015,44(1):186-198.
[10] LI D.Diabetes and pancreatic cancer[J].Mol Carcinog,2012,51(1):64-74.
[11] DUAN W,SHEN X,LEI J,et al.Hyperglycemia,a neglected factor during cancer progression[J].Biomed Res Int,2014,2014:461917.
[12] 黎韡,徐勤鸿,马清涌.高糖状态对胰腺癌细胞氧化应激水平的促进作用[J].西安交通大学学报(医学版),2016,37(6):789-794.
[13] LI W,ZHANG L,CHEN X,et al.Hyperglycemia promotes the epithelial-mesenchymal transition of pancreatic cancer via hydrogen peroxide[J].Oxid Med Cell Longev,2016,2016:5190314.
[14] LI J,MA Q.Hyperglycemia promotes the perineural invasion in pancreatic cancer[J].Med Hypotheses,2008,71(3):386-389.
[15] HAN L,MA Q,LI J,et al.High glucose promotes pancreatic cancer cell proliferation via the induction of EGF expression and transactivation of EGFR[J].PLoS One,2011,6(11):e27074.
[16] LIU H,MA Q,LI J.High glucose promotes cell proliferation and enhances GDNF and RET expression in pancreatic cancer cells[J].Mol Cell Biochem,2011,347(1-2):95-101.