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Unique Biology of Pancreatic Ductal Adenocarcinoma Accompanied by Rapidly Impaired Diabetes: A Favorable Long-Term Survival Following Curative Resection

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Pancreatic ductal adenocarcinomas (PDACs) are sometimes diagnosed accompanied by rapidly impaired diabetes (PDAC-RID). Although this type of PDAC may have unusual biological features, these features have not been explained.

Methods

Patients with PDAC who underwent upfront pancreatectomy between 2010 and 2018 were retrospectively reviewed. PDAC-RID was defined as a glycated hemoglobin (HbA1c) value of ≥ 8.0% of newly diagnosed diabetes, and acute exacerbation of previously diagnosed diabetes. Other patients were classified as PDAC with stable glycometabolism (PDAC-SG). Clinicopathological factors, long-term survival rates, and recurrence patterns were evaluated.

Results

Of the 520 enrolled patients, 104 were classified as PDAC-RID and 416 as PDAC-SG. There was no significant difference regarding TNM staging, resectability, or adjuvant chemotherapy rate between the groups. However, 5-years cancer-specific survival (CSS) was significantly higher in the PDAC-RID group than in the PDAC-SG group (45.3% vs. 31.1%; p = 0.02). This survival difference was highlighted in relatively early-stage PDAC (≤ pT2N1) (CSS: 60.8% vs. 43.6%; p = 0.01), but the difference was not significant for advanced-stage PDAC. A multivariate analysis of early-stage PDAC showed that PDAC-SG was an independent risk factor of shorter CSS (hazard ratio 1.76; p = 0.02). The hematogenous metastatic rate in early-stage PDAC was lower in the PDAC-RID group than in the PDAC-SG group (18.3% vs. 35.8%; p = 0.01).

Conclusions

PDAC-RID showed a favorable long-term survival rate after curative resection with low hematogenous metastases, which may be due to its unique biology.

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Acknowledgment

This research was supported by a Grant-in-Aid for Research from the National Center for Global Health and Medicine (19A2013). The authors thank Ellen Knapp, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Sho Kiritani MD, PhD, Yoshihiro Ono MD, PhD, Atsushi Oba MD, PhD, Takafumi Sato MD, PhD, Hiromichi Ito MD, PhD, Yosuke Inoue MD, PhD & Yu Takahashi MD, PhD

  2. Department of Pathology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Manabu Takamatsu MD, PhD

  3. The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Chiba, Japan

    Sachiyo Yoshio MD, PhD

  4. Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan

    Mamiko Miyashita MD, PhD & Akio Saiura MD, PhD

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  1. Sho Kiritani MD, PhD
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Correspondence to Yoshihiro Ono MD, PhD or Yu Takahashi MD, PhD.

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Disclosure

Sho Kiritani, Yoshihiro Ono, Manabu Takamatsu, Sachiyo Yoshio, Mamiko Miyashita, Atsushi Oba, Takafumi Sato, Hiromichi Ito, Yosuke Inoue, Akio Saiura, and Yu Takahashi have no conflicts of interest associated with this study.

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10434_2023_14408_MOESM1_ESM.tif

Supplementary fig.1 1 Subgroup analysis of CSS according to T and N factors. (a–c) Kaplan–Meier curves based on the T factor. (d–f) Kaplan–Meier curves based on the N factor. CSS cancer-specific survival, PDAC-RID pancreatic ductal adenocarcinoma accompanied by rapidly impaired diabetes, PDAC-SG pancreatic ductal adenocarcinoma with stable glycometabolism (TIF 87 KB)

Supplementary file2 (TIF 93 KB)

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Supplementary file6 (TIF 89 KB)

10434_2023_14408_MOESM7_ESM.tif

Supplementary fig. 2 Distribution of subdivided venous invasion between PDAC-RID and PDAC-SG. PDAC-RID pancreatic ductal adenocarcinoma accompanied by rapidly impaired diabetes, PDAC-SG pancreatic ductal adenocarcinoma with stable glycometabolism, v0 no evidence of venous invasion, v1 slight venous invasion, v2 moderate venous invasion, v3 marked venous invasion (TIF 91 KB)

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Kiritani, S., Ono, Y., Takamatsu, M. et al. Unique Biology of Pancreatic Ductal Adenocarcinoma Accompanied by Rapidly Impaired Diabetes: A Favorable Long-Term Survival Following Curative Resection. Ann Surg Oncol 31, 514–524 (2024). https://doi.org/10.1245/s10434-023-14408-0

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