RECENT ONSET DIABETES IS ASSOCIATED WITH BETTER SURVIVAL IN PDAC- AN ANALYSIS OF PREOPERATIVE SYMPTOMS WITHIN THE DGAV STUDOQ|PANCREAS REGISTRY
Yannic Elser*, Louisa Bolm, Steffen Deichmann, Rüdiger Braun, Ekaterina Petrova, Hryhoriy Lapshyn, Ulrich F. Wellner, Tobias Keck, Kim C. Honselmann
Universitatsklinikum Schleswig Holstein - Campus Lubeck, Lubeck, Schleswig-Holstein, Germany
Pancreatic ductal Adenocarcinoma (PDAC) is one of the most aggressive cancers and ranks among the leading causes of cancer-related deaths in the Western World. This highly malignant tumor still has a dismal prognosis, largely due to its late diagnosis and high drug resistance. Even though it is a common perception that PDAC is asymptomatic and painless, recent clinical data is lacking. For this reason, this study analyzed the relationship between preoperative symptoms and post surgical outcomes utilizing the German national StuDoQ database.
Data were prospectively collected by a multitude of German academic center within the pancreatic surgery registry (StuDoQ|Pancreas) of the German Society for General and Visceral Surgery (DGAV). Patients were included if they underwent pancreatic head resection for pancreatic adenocarcinoma (PDAC) from Jan. 1st, 2013- Dec. 31st, 2017. Statistical analysis was performed in SPSS Version 25.
A total of 2643 patients who underwent pancreatic head resection for PDAC were included in the study. Patients had a median age of 71 years (IQR 63-78) and 54% were male. Preoperative symptoms were common, with 2380 of 2643 (90%) presenting with any one or more of the following symptoms: jaundice (40%), biliary stent (41%), pain (37%), weight loss (29%), nausea (18%), diabetes (31%). Increasing number of symptoms correlated with worse overall survival (log rank p<0.001) (Figure 1). Patients were separated into three groups according to PDAC symptoms (symptoms (n=2229) (including jaundice, biliary stent, pain, weight loss, nausea, diabetes)/ recent onset diabetes (ROD) (n=121)/ no symptoms (all others) (n=293)). The three groups differed in CA19-9 (no symptoms: 108 U/L, symptoms: 120 U/L, ROD: 285 U/L, p= 0.003), BMI (no symptoms: 24.5 kg/m2, symptoms: 25 kg/m2, ROD: 26.2 kg/m2, p=0.007)) and lymph nodes (no symptoms: N0: 36%, N1: 55%, N2: 10%, symptoms: N0: 31%, N1: 53%, N2: 17%, ROD: N0: 28%, N1: 56%, N2: 16%, p=0.023).
Interestingly, ROD (defined as diabetes occurring within a year before surgery) presented in 121 patients (4%) and was associated with better survival after resection compared to patients with other or no symptoms (Median OS: 28 months (no symptoms at all), 22 months (symptoms) vs. not reached in the ROD group (log rank, p=0.013)).
Despite common perception, PDAC symptoms occur in up to 90% of resectable PDAC patients. In addition, PDAC symptoms are associated with overall survival and might identify unique PDAC subtypes.
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