The Relationship Between Serum Lipid Level And Risk,Clinical Feature And Postoperative Short Outcome Of Pancreatic Cancer

Partl The relationship between serum lipid level and risk of pancreatic cancerObjective:Pancreatic cancer is a highly fatal digestive system malignancy.The determination of the risk factors for its occurrence are important measures to reduce the incidence of cancer.Many malignant tumors have abnormal blood lipid levels,but relatively few studies have examined the relationship between blood lipid levels and pancreatic cancer.This study focus on the common blood lipids and discusses their possible value in the risk and diagnosis of pancreatic cancer,and establishes a blood lipid level-related pancreatic cancer screening model.Methods:Patients who were diagnosed as pancreatic ductal adenocarcinoma by pathological or imaging examinations were collected from January 2008 to January 2017 in the hepatobiliary and pancreatic department at the Second Affiliated Hospital of Zhejiang University School of Medicine.At the same time,a healthy individual group matched with gender and age was randomly selected from the group of routine physical examinations in the hospital during the same period as a control group.The following data were collected for each case and control group:gender,age,BMI,smoking history,drinking history,common blood lipids and CA199 values.By preparing the ROC curve,the possible value of common lipid markers in the diagnosis of pancreatic cancer was evaluated.At the same time,logistic regression analysis was used to investigate possible risk factors for the development of pancreatic cancer,and establish a screening model as well as evaluate it.Results:Compared with healthy subjects,serum TC levels in patients with pancreatic cancer were reduced(p<0.001)and HDL-C levels were decreased(p<0.001),while there was no significant difference in TG levels and LDL-C levels.Meanwhile,in patients with pancreatic cancer,the proportion of hypercholesterolemia decreased(p<0.001),the proportion of low HDL hyperlipidemia(p<0.001)and high LDL hyperlipidemia(p=0.001)increased,and the proportion of hypertriglyceridaemia was comparable to that of the control group.Serum TC levels(AUC=0.622,p<0.05)and HDL-C levels(AUC=0.673,p<0.05)had certain accuracy in the diagnosis of pancreatic cancer.The best cutoff points were TC?4.87mmol/L and HDL-C?1.06mmol/L,while TG levels(AUC=0.572,p=0.109)and LDL-C levels(AUC=0.503,p=0.875)had no significant value in the diagnosis of pancreatic cancer.The pancreatic cancer screening model combined with BMI,TC,HDL-C,LDL-C,CA199 and smoke history(AUC=0.944,p<0.001,the optimal cut-off point for diagnosis was>4 points)has a higher accuracy compared with CA199 alone(p<0.001).Conclusion:Patients with pancreatic cancer have abnormal serum lipid levels,such as lower serum TC levels and lower HDL-C levels.Blood lipid level has certain accuracy in the diagnosis of pancreatic cancer.The combination of lipid-level scoring models can facilitate the screening of high-risk pancreatic cancer patients.Part2 The relationship between serum lipid level and clinical feature and postoperative short outcome of pancreatic cancerObjective:To identify and control the risk factors on postoperative complications and length of hospital stay in patients undergoing surgery is an important way to promote early rehabilitation.Lipid metabolism is closely related to the occurrence and development of pancreatic cancer.However,there is currently no relevant research on the relationship between serum lipid levels and clinical features and postoperative short outcome of patients with pancreatic cancer.This study conducted a preliminary exploration of this relationship.Methods:From January 2008 to August 2017,patients with pancreatic cancer in the hepatobiliary and pancreatic department at the Second Affiliated Hospital of Zhejiang University School of Medicine were collected.The following data were collected by referring to the medical record system:gender,age,BMI,history of diabetes,hypertension,smoking history,drinking history,clinical manifestations,tumor characteristics,lipid profile,preoperative examination,perioperative death,postoperative complications,length of stay,postoperative hospital stay,etc.The differences in clinical manifestations,tumor characteristics,perioperative mortality,length of stay,postoperative hospital stay,and postoperative complications were compared between subgroups with different lipid levels.At the same time,univariate and multivariate analyses were performed on some of the possible factors that influence postoperative hospital stay in patients with pancreatic cancer,including lipid levels.Results:The dyslipidemia subgroup of patients with pancreatic cancer was more likely to accompany the symptoms of jaundice than the normal lipid subgroups(p<0.001).Patients with hypercholesterolemia had relatively small tumors(p=0.026)and earlier tumor stages(p=0.021),whereas tumors in patients with low HDL-Cemia and high LDL-C hyperlipidemia were more common at the pancreatic head(p<0.001,p=0.028).For patients with surgical treatment of pancreatic cancer,multivariate analysis showed risk factors for prolonged postoperative hospital stay in patients with hypercholesterolemia and postoperative complications.There were no significant differences in the incidence of complications such as postoperative bleeding,pancreatic fistula,delayed gastric emptying,and perioperative mortality between the different lipid levels subgroups and their respective normal lipid subgroups.Conclusion:Dyslipidemia is associated with clinical features such as jaundice in patients with pancreatic cancer.There is no significant relationship between dyslipidemia and postoperative complications in surgical patients with pancreatic cancer,but hypercholesterolemia is a risk factor for prolonged postoperative hospital stay.For this group of patients,blood lipid levels should be actively controlled to promote early recovery.Part3 Meta-analysis of blood lipid level and risk of pancreatic cancerObjective:For the relationship between clinical common blood lipids and the risk of pancreatic cancer,the current research is still controversial,and some even get the opposite result.This study hopes to conduct meta analysis by incorporating relevant literature and further discuss the relationship between these two.Methods:A systematic review of the literature on the relationship between blood lipid level and the risk of pancreatic cancer between January 1987 and August 2017 in the PubMed and Medline databases was performed.After a selection based on a certain exclusion criteria,the authors' name,year of publication,research nation,research type,number of cases and controls,gender,age,lipid profile,the RR or OR value of pancreatic cancer risk between maximal blood lipid level and lowest blood lipid level and relevant bias indicators were collected.A meta-analysis of the relationship between TC,TG,and HDL-C levels and risk of pancreatic cancer was performed.Stratified analysis on research zone,research time and study type of TC level and pancreatic cancer risk were performed.Results:A total of 3,091,664 participants and 8002 cases in 11 articles were included in the meta-analysis of TC,TG,and HDL-C levels and the risk of pancreatic cancer.Among them,serum TG level(OR=1.09,95%CI:0.91-1.30,p=0.33)and HDL-C level(OR=1.02,95%CI:0.83-1.25,p=0.86)were not significant association with the risk of pancreatic cancer.While serum TC level and pancreatic cancer risk were not significantly different in the overall analysis(OR=0.93,95%CI:0.81-1.06,p=0.28),they were negatively correlated in the cohort study subgroup(OR=0.91,95%CI:0.84-0.99,p = 0.03)or subgroup of the number of cases>500(OR=0.90,95%CI:0.83-0.98,p=0.03).Conclusion:High-quality and large-sample studies show that serum TC level is negatively correlated with the risk of pancreatic cancer.Serum TG level and HDL-C level have no significant relationship with pancreatic cancer risk.