Effect Of Hyperglycemia On The Pathological Features Of Pancreatic Cancer And Prognosis After Radical Resection

BackgroundPancreatic cancer is a kind of digestive system tumor with a high degree of malignancy.Due to its insidious onset,less than 20%of patients have the chance of radical resection when seeing a doctor,and the prognosis after radical resection is poor.Studies have shown that diabetes is associated with early nerve infiltration,lymph node metastasis and other organ metastasis in pancreatic cancer,which leads to poor prognosis of pancreatic cancer patients.Vascular tumor emboli refers to the infiltration of tumor cells in lymphatic vessels or blood vessels.When vascular tumor emboli appears,it means that the tumor may have hematogenous dissemination or lymph node metastasis,and its presence also makes the prognosis of tumor patients poor.The relationship between diabetes mellitus and pancreatic cancer has been widely reported,but the analysis of the relationship between hyperglycemia and the formation of pancreatic vascular tumor emboli、nerve infiltration and the prognosis after radical resection from the perspective of preoperative blood glucose is rare.Therefore,it is necessary to study the effect of hyperglycemia on the pathological characteristics of pancreatic cancer and the prognosis after radical resection,which is of great significance for the prevention of early metastasis of pancreatic cancer、the guidance of surgical treatment,and the improvement of prognosis of pancreatic cancer patients.PurposeStudy the effect of hyperglycemia on the pathological features of pancreatic cancer and on prognosis after radical resection.MethodsFrom January 2012 to December 2017,clinical records of 99 cases of patients with pancreatic cancer who received radical surgery for pancreatic cancer in the first affiliated hospital of Zheng Zhou university and were confirmed as pancreatic duct adenocarcinoma by postoperative pathology,without distant metastasis and without preoperative radiotherapy or chemotherapy were also requested.All patients were diagnosed preoperatively by ultrasound,CT,MRI,ERCP,PET-CT or pathological biopsy,and the patients were treatedwith oral sergio capsules postoperatively.Patients with a history of diabetes patients were asked to use hypoglycemic drugs as usual,then we measure the fasting glucose values,according to whether the fasting glucose values were greater than 7.0 mmol/L,these patients were divided into high blood sugar group and normal blood sugar group,and observe each group patients with preoperative indicators(age、gender、CA19-9,preoperative fasting blood sugar),pathological characteristics(tumor site、tumor size、tumor differentiation degree、nerve infiltration、vascular tumor emboli,TNM stage)and postoperative index(survival time).Follow-up visit was conducted by telephone,text message and outpatient service.The start date of follow-up visit was the date of surgery,and the end date was June 2018 or the death of the patient.SPSS 21.0software was used to measurement group data,convert them into counting data,and conduct single factor analysis with x~2 test.Kaplan-Meier method was used for survival analysis between the two groups,and log-rank test was used to compare the difference in prognosis.Multivariate analysis was tested with Cox regression model.ResultsThere were 33 cases(33.3%)in the hyperglycemia group and 66 cases(66.7%)in the normal blood glucose group.The differences between gender、age、CA19-9、tumor site、tumor size、differentiation degree and TNM stage in two groups has no statistically significant difference,(P>0.05).Compared with the two groups of patients in terms of nerve infiltration,vascular tumor emboli and lymph node metastasis,P<0.05,indicating a statistically significant difference.The median survival time were(12.3±0.8)months in the hyperglycemia group and(15.4±2.9)months in the normal blood glucose group.The postoperative median survival time were significantly shorter in the hyperglycemia group than in the normal blood glucose group(P<0.05).The median survival time were(8.0±1.9)months for pancreatic cancer patients with vascular tumor emboli,and(15.0±1.0)months for those without vascular tumor emboli(P<0.05).The median survival time of pancreatic cancer patients with nerve infiltration was(13.2±2.1)months,which was shorter than that of those without nerve infiltration(17.2±1.9)months,and the difference was statistically significant(P<0.05).COX proportional risk regression model showed that blood glucose、degree of differentiation、TNM stage、nerve infiltration and vascular tumor emboli were independent factors affecting the prognosis of pancreatic cancer.Conclusions1.Hyperglycemia has an effect on the formation of vascular tumor emboli of pancreatic cancer,and patients with hyperglycemia are more likely to be associated with the formation of pancreatic vascular tumor emboli.2.Hyperglycemia has an effect on nerve infiltration of pancreatic cancer,and patients with hyperglycemia are more likely to be associated with nerve infiltration.3.Hyperglycemia has an effect on lymph node metastasis of pancreatic cancer,and patients with hyperglycemia are more likely to to be associated with lymph node metastasis.4.The survival time of pancreatic cancer patients with hyperglycemia after radical resection is shorter than that of those without hyperglycemia.5.Hyperglycemia,tumor differentiation,TNM stage,nerve infiltration,and vascular tumor emboli were independent factors affecting the prognosis of pancreatic cancer.