| Object :Pancreatic cancer (PC) is a familiar malignancy. The earlysymptoms of PC are nonspecific. PC is often found late in the course ofdisease. The pathogenesis of PC has been still indistinct. Recently people havebegun to pay attention to the relationship between diabetes mellitus (DM) andPC. Some data have demonstrated that the relationship between DM and PC isclose. Our aim is to investigate the incidence of DM in PC patients to acquaintthe relationship among PC family history, DM family history and DM in PCpatients and make sure if DM is risk factor of PC and to detect glucose ,insulinand C-peptide to analyze the characters of DM.Methods: 721 PC cases hospitalized between January 1994 andDecember 2004 according to diagnostic standard of PC. Controls enrolled1887 patients admitted to the department of Cardiology, Respiratory,Otolaryngology and Ophthalmology of the same hospital who were unaffectedby cancer. PC family history, DM family history and DM were registered.The level of glucose ,insulin and C-peptide were detected. Statistics methods:analysis of single factor adopted χ2 test and odds ratios(ORs) and their 95%confidence interval was calculated to estimate relative risk.Results: The incidence of DM in PC patients is 14.15%.There are notdistinct differences in the level of glucose ,insulin and C-peptide betweenDM in PC patients and DM in patients unaffected by cancer.The odds ratio(OR ) undergoing PC with DM is 6.45 ; the OR with DM in male patients is6.57.The similar figure in female patients is 6.25;the OR with PC familyhistory is 7.14 and the OR with DM family history is 4.68; the OR with DM inwithout PC family history patients is 5.14 and the OR with DM in with PCfamily history patients is 5.19;the OR with DM in without DM familyhistory patients is 5.41 and the OR with DM in with DM family historypatients is 5.28; the OR is 7.10 in the patients whose course of DM from 0 to 2years ,the OR is 3.27 in the patients whose course of DM from 2 to 5years ,the OR is 8.42 in the patients whose course of DM above 5 years .72.55% of the total patients undergoing PC with DM are the patients of thecourse of DM from 0 to 2 years. Discussion: Epidemiological studies on PC have proved that potentialrisk factors include smoking, high fatty diet, coffee and alcohol intake andoccupational exposure to certain pesticides. Recently some data havedemonstrated that the relationship between DM and PC are close. We find theincidence of DM in PC patients is 14.15% and the rate of controls is 2.50%. Adistinct difference exists between the two groups. The results are similar withFisher's study that incidence of PC in DM patients is 1.5-7 times higher thanthat of the healthy public. Studying 721 PC patients with DM, we find the ORis 6.45 and the OR is 7.10 with the course of DM within 2 years. The resultssuggest DM within 2 years may be an early signal of PC.We find that the ORis 8.42 with the course of DM over 5 years and the OR is 3.27 with thecourse of DM during 2 to 5years. The results suggest that increasing thecourse of DM may be increase risk for PC. The results are similar withBonelli's study. To exclude the interference sex for the results, we usestratification analytical method to find that the OR with DM in PC patients inmale is 6.57,and the OR is 6.25 in female. The results are similar withCoughlin's study that DM increased the risk of PC, the RR was 1.48 in maleand the RR was 1.44 in female. We find that DM increases the risk of PCeither male or female, and there are not distinct differences between sexes. Wealso find that both PC family history and DM family history increase the riskof PC. The possible mechanism that DM increased risk of PC is as follows:1.DM is a signal of long –term dysfunction of pancreas. Consistent glycemiacan stimulate pancreatic adenoid cell chronically, thus can result inPC.2.Insulin resistance in DM is associated with islet cell transform, stimulatepancreatic cell differentiation and enhance leading to PC.3.Glucose and freefatty acid in DM can result in pancreatic canal cell hyperplasia, then lead tocancer, moreover the two matters can provide energy for having formed PC.DM directly or indirectly cause hyperinsulinemia and the high level of insulinshow mitogenic is properties and biology function though IGF-I. IGF-1binding IGF-IR can inhibit apoptosis, promotes cell split and increases cellularturnover may enhance the accumulation of molecular alteration. In animalexperiment, isolate rat pancreatic islet was incubated in culture mediaconditioned by human PC cell. After 2-5 days, PC cells increased 50% thancontrol's .The study suggested insulin promoted Pc cell growth. We find that72.55% DM associated with PC is diagnosed during the 2 years before thecancer is found. The results are similar with the recent foreign studies. Thesesuggest that recently-developed diabetes may be a consequence of pancreaticcancer and may be an early sign of PC. Several studies have demonstrated thatdiabetes in pancreatic cancer patients is characterized by peripheral insulinresistance .Basso has verified a peptide at 2030 MW may be a putativepc-associated diabetogenic factor through human PC cells culture. The tissues... |
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