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[Abnormal metabolism of glucose as clue for early diagnosing pancreatic cancer].

OBJECTIVE
To investigate the incidence, features, and course of abnormal metabolism of glucose in patients with pancreatic cancer and the possibility of using the abnormal metabolism of glucose as early precursory manifestation of pancreatic cancer.


METHODS
Fasting plasma-sugar (FPG), plasma insulin and C peptide were examined in 98 patients with pancreatic cancer diagnosed by B mode ultrasonography, CT, endoscopy, and pathological examination. The family history of DM was collected. The body mass index (BMI) was calculated. The relation between abnormal metabolism of glucose and diagnosis of pancreatic cancer was analyzed. One hundred and fifteen patients with advanced gastric cancer (AGC), 87 patients with colon cancer, and 146 patients with type 2 diabetes mellitus (DM) were used as controls.


RESULTS
Abnormality of FPG, insulin and C peptide was found in 17 out of the 98 patients with pancreatic cancer, with an incidence rate of 17.4%, significantly higher than that in patients with AGC (1/115, 1.7%, P < 0.05), and patients with colon cancer (5/87, 5.8%, P < 0.025). Thirty eight patients with type 2 DM (39.0%) had their BMI > 24, while no pancreatic cancer patients with abnormality of metabolism of glucose had his BMI > 24 (0/17, 0%, P < 0.05). The duration between the discovery of abnormal metabolism of glucose and the diagnosis of cancer in the 17 patients was 10.8 +/- 7.4 months, and was < 2 years in 15 of them (88.2%), significantly longer than the duration between the appearance of symptoms and the diagnosis in the 146 type 2 DM patients (21/146, 14.4%, P < 0.05). The proportion of positive DM family history was 1/17 in patients with pancreatic cancer, significantly lower than in patients with type 2 DM (97/146, 66.4%, P < 0.05). However, the values of FPG, insulin, and C peptide between the groups with and without pancreatic cancer were not significantly different.


CONCLUSION
Clinical manifestations of abnormal metabolism of glucose appear prior to the discovery of space occupying lesions in pancreas in about 17% patients with pancreatic cancer. Newly appearing abnormalities in metabolism of glucose in patients without DM family history and without symptom of obesity should be regarded as important clues for early diagnosing pancreatic cancer.