Long-Term Diabetes Mellitus Is Associated with an Increased Risk of Pancreatic Cancer: A Meta-Analysis

PLOS ONE, Jul 2015

Purpose Previous studies have shown a bidirectional relationship between diabetes and pancreatic cancer (PC). In particular, new-onset diabetes might be induced by PC, and people with long-term diabetes might be at increased risk for the development of PC. The purpose of our study was to examine whether long-term diabetes represented an independent risk factor for PC development. Methodology A literature search was performed by searching electronic databases for studies published before July 1, 2014, and relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated. Data pertaining to diabetes were recorded at both individual and study levels, with RRs calculated separately to analyze the relationship between the duration of diabetes and the development of PC. Results Forty-four studies were included in this meta-analysis, including 18 studies with a case-control design, 5 with a nested case-control design and 21 with a cohort design. The overall summary estimate for the relationship between the population with a duration of diabetes ≥2 years and PC was 1.64 (1.52-1.78). The pooled RR (95% CI) of PC for the population with a duration of diabetes ≥5 years was 1.58 (1.42-1.75). For the population with a duration of diabetes ≥10 years, the RR (95% CI) of PC was 1.50 (1.28-1.75). Conclusions Our study suggests that long-term diabetes mellitus is associated with an increased risk of PC. However, the level of risk is negatively correlated with increasing diabetes mellitus duration.

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Long-Term Diabetes Mellitus Is Associated with an Increased Risk of Pancreatic Cancer: A Meta-Analysis

July Long-Term Diabetes Mellitus Is Associated with an Increased Risk of Pancreatic Cancer: A Meta-Analysis Shanshan Song 0 1 2 Baosheng Wang 0 1 2 Xin Zhang 0 1 2 Liliang Hao 0 1 2 Xianliang Hu 0 1 2 Zhongxiang Li 0 1 2 Shaolong Sun 0 1 2 0 Department of Pancreas and Breast Surgery, Shengjing Hospital of China Medical University , Shenyang, Liaoning , China 1 Funding: This work was supported by a grant from the Science and Technology Department of Liaoning Province (2013225021). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript 2 Editor: Olaf M. Dekkers, Leiden University Medical Centre , NETHERLANDS - Competing Interests: The authors have declared that no competing interests exist. Purpose Methodology Results Conclusions Introduction 2 / 27 Methods Search strategy and selection criteria Data extraction Quality assessment 3 / 27 Statistical analyses 4 / 27 Results Study characteristics and quality assessment results Meta-analysis results 5 / 27 Case (DM with elected duration/ Non-DM), N Control (DM with elected duration/ Non-DM), N Prevalence OR Age and gender Author/year/ region Cuzick/1989/ England [16] Farrow/1990/ America [17] Jain/1991/ Canada [18] Bueno de Mesquita/ 1992/the Netherlands (M) [19] Bueno de Mesquita/ 1992/the Netherlands (F) [19] Gullo/1994/ Italy [20] Lee/1996/ China [21] Bonelli/2003/ Italy [23] Both (48.5) Both (78.7) Both (50.0) Both (57.4) Both (57.7) Patients with nontumor disease, the same hospital and period Physical checkup, the same hospital and period Patients with nontumor disease, the same hospital and period Patients with nontumor disease, the same hospital and period Patients with nontumor disease, the same hospital and period Sampling scheme a [70] Adjusted factors Control selection Patients with nontumor disease, the same hospital and period Interpretation of reported effect measure Prevalence OR Prevalence OR Age, smoking and education Smoking, calories and fiber intake Age, response status and smoking Age, response status and smoking Smoking, alcohol, history of cholecystectomy and gastric resection Age, gender, smoking, alcohol, center, education and occupation Age, gender, and residence (Continued ) Both (54.5) Prevalence OR 35–80 Female Prevalence OR Prevalence OR Prevalence OR Prevalence OR Prevalence OR Prevalence OR 6 / 27 Case (DM with elected duration/ Non-DM), N Control (DM with elected duration/ Non-DM), N Prevalence OR Prevalence OR Prevalence OR Prevalence OR Prevalence OR Prevalence OR Prevalence OR Table 1. (Continued) Author/year/ region Kuang/2009/ China [26] Maisonneuve/ 2010/Australia, Canada, the Netherlands and Poland [27] Lipworth/2011/ Italy [29] Ben/2011/ China [30] Henry/2013/ USA (1) [32] Both (55.7) Both (65.7) Both (52.5) Both (57.8) Both (65.9) Both (66.9) Both (53.4) Both (57.6) Prevalence OR Sampling scheme a [70] Adjusted factors Interpretation of reported effect measure Control selection Patients with nontumor disease, the same hospital and period Patients with nontumor disease, the same hospital and period Patients with nontumor disease, the same hospital and period Patients with nontumor disease, the same hospital and period Age, gender, race, education, smoking, alcohol, body mass index (BMI) and study site Age, gender, smoking, BMI, center, year of interview and education Age, smoking, alcohol, family history of pancreatic cancer Age, gender, center, year of interview, education, alcohol, smoking and BMI Age, gender, race, education, smoking, alcohol and pack-years te re fec eas R R R In fo fe m R R R In In In /2 ]4 / 1 [3 1 and ]53 / 3 889 ]33 0 0 , /tt1 [A /re2n edne /2an ldna ,A repo i[an ia S tt w le in S u h H U A S E F U E C 8/27 R R R R R R R R R R R R A A A – – – 0 5 0 5 0 9 3 9 3 9 5 6 – – – 0 9 0 9 0 9 4 7 4 7 4 6 0 0 e F e o 0 e o 0 ltoS looSm /0220 []41 hanK Japa []42 hanK Japa []42 /o2Lu Jpana ][34 /e2 rea ] /e2 rea ] z J K [4 J K [4 sed lua sed lua sed lua o p o p o p l o l o l o C p C p C p Icn csa Icn csa Icn csa a u a u n p n p o p y o y o l o D p D p C p t t t n n n e s e s e s id e id e id e Icn csa Icn csa Icn csa 5 5 5 2 .6 (m .67 f(em 10 10 10 8 a . s s s ll ge ll ge ll ge A a A a A a m d w d A S hbS 1994 []38 C S a e i o e d w h w d d d e e e e e e h m h m h m tc it tc it tc it a n a n a n M o M o M o n n n ic ito ic ito ic ito m la m la m la a u a u a u n p n p n p y o y o y o D p D p D p t t t n n n e s e s e s id e id e id e Icn csa Icn csa Icn csa Y /8 .54 /3 .94 ( . . / 8 2 5 6 6 3 0 1 7 7 8 7 6 8 6 ) 1 6 ) 2 1 12 17 (Y 11 25 (Y 3 4 0 6 se tn se tn se tn a a a ne it ne it ne it a b a b a b p a p a p a Ja inh Ja inh Ja inh 9 / 27 N e s M o N 10 / 27 11 / 27 12/27 N r r 0 0 0 0 0 13/27 m in to o a c C M fa * * * * * * * * * * * * * * * e leS teh exp * * * * * * * * * * * * * * * o h t t 14/27 16 / 27 Sensitivity analysis and subgroup 17 / 27 Publication bias Discussion 18 / 27 19 / 27 20 / 27 a 2 ea o tu 5 6 8 n y N s 1 1 1 a y N s 2 3 7 E m R R R F R F R 7 0 0 t. 1 2 3 4 1 1 2 3 5 2 1 3 1 0 . e n s s o lea laeem -sea ltrono tyud tsede -sea ltroon tyud troho tydu trsena itrneuo trsene itrneou l.ranpou M F C c s N c c s C s E c W c j/ 1 7 r 3 e n .1 d yd ign io 0 en tu se ge i:1o G S d R d 21 / 27 22 / 27 23 / 27 References 24 / 27 25 / 27 26 / 27 1. 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Shanshan Song, Baosheng Wang, Xin Zhang, Liliang Hao, Xianliang Hu, Zhongxiang Li, Shaolong Sun. Long-Term Diabetes Mellitus Is Associated with an Increased Risk of Pancreatic Cancer: A Meta-Analysis, PLOS ONE, 2015, DOI: 10.1371/journal.pone.0134321