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Association of Diabetes Mellitus and Pancreatic Adenocarcinoma: A Meta-Analysis of 88 Studies

  • Pancreatic Tumors
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Abstract

Background

Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at an advanced, incurable stage. Previous epidemiological data suggests that diabetes mellitus (DM) is a risk factor for PDAC, which may be important in early detection. However, the strength of this association needs to be determined, taking into account a number of recently published studies.

Methods

A systematic review of the association between DM and PDAC was undertaken by searching electronic databases and journal references from 1973 to 2013. Summary estimates were obtained separately for case–control and cohort studies by means of a ‘random effects’ approach. Data pertaining to the DM was recorded and plotted at both an individual and study level, with the relative risks (RR) pooled separately to determine the relationship of DM duration and PDAC.

Results

A total of 88 independent studies, including 50 cohort and 39 case–control studies were examined. The overall summary-combined RR was 1.97 (95 % CI 1.78–2.18) with marked heterogeneity that could not be clearly attributed to any subgroup analyses. The risk of PDAC was greatest early after the diagnosis of DM but remained elevated long after the diagnosis. The individual-level RR ranged from 6.69 at less than 1 year to 1.36 at 10 years.

Conclusion

The results demonstrate a strong association between PDAC and recently diagnosed DM, which may be attributed to a paraneoplastic effect. However, the presence of diabetes also remains a modest risk factor for the development of PDAC long-term. Selective screening of patients with new-onset DM for PDAC needs to be considered.

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Acknowledgment

Pikli Batabyal, Stephen Vander Hoorn, Christopher Christophi, and Mehrdad Nikfarjam declare no competing source of financial or material support or commercial interest in the subject of the study.

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Authors and Affiliations

  1. Department of Surgery, University of Melbourne, Austin Health, LTB 8, 145 Studley Rd, Heidelberg, Melbourne, VIC, 3084, Australia

    Pikli Batabyal MBBS, Christopher Christophi MD, FACS, FRACS & Mehrdad Nikfarjam MD, PhD, FRACS

  2. Statistical Consulting Centre, Department of Mathematics and Statistics, University of Melbourne, Melbourne, VIC, Australia

    Stephen Vander Hoorn MSc, BSc

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  1. Pikli Batabyal MBBS
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  2. Stephen Vander Hoorn MSc, BSc
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  3. Christopher Christophi MD, FACS, FRACS
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  4. Mehrdad Nikfarjam MD, PhD, FRACS
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Correspondence to Mehrdad Nikfarjam MD, PhD, FRACS.

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Batabyal, P., Vander Hoorn, S., Christophi, C. et al. Association of Diabetes Mellitus and Pancreatic Adenocarcinoma: A Meta-Analysis of 88 Studies. Ann Surg Oncol 21, 2453–2462 (2014). https://doi.org/10.1245/s10434-014-3625-6

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  • DOI: https://doi.org/10.1245/s10434-014-3625-6

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