To detect and analyze the value of adipokines in the diagnosis and prognosis of patients with pancreatic cancer complicated with diabetes.

From July 2012 to June 2013, 24 pancreatic ductal adenocarcinoma (PDAC) complicated with diabetes mellitus (DM) (study group), 30 PDAC (control group A) and 31 DM (control group B) cases were collected. Serum levels of adiponectin, resistin, leptin and visfatin were tested and the differences were compared among different groups. Receiver operator characteristic (ROC) curves were used to analyze the diagnostic value of the above cytokines. The patients were followed up for two to 58 months. Kaplan-Meier survival curve was performed to analyze the prediction value of above cytokines in recurrence-free survivals (RFS) in patients with PDAC complicated with DM. Chi square test, t test and Mann-Whitney U test were used for statistical analysis.

The median levels of serum adiponectin and resistin of study group were both higher than those of control group B (36.92 mg/L , 15.80 mg/L to 101.57 mg/L vs 12.84 mg/L, 5.64 mg/L to 21.39 mg/L; 9.07 μg/L, 6.39 μg/L to 12.19 μg/L vs 5.93 μg/L, 4.22 μg/L to 7.68 μg/L, respectively), and the differences were statistically significant (Z=-3.462 and -2.868, P=0.001 and 0.004, respectively). However the serum levels of leptin and visfatin of study group were both lower than those of control group B (1.02 μg/L, 0.11 μg/L to 2.06 μg/L vs 1.92 μg/L, 0.96 μg/L to 2.72 μg/L; 2.43 μg/L, 0.48 μg/L to 4.28 μg/L vs 4.18 μg/L, 2.43 μg/L to 7.28 μg/L), and the differences were statistically significant (Z=-1.986 and -2.336, both P<0.05). The results of ROC curve analysis of adipokines in differential diagnosis of pancreatic cancer from diabetes indicated that the areas under the curve (95% confidence interval) of serum adiponectin, resistin, leptin and visfatin in the diagnosis of PDAC were 0.774 (0.645, 0.903), 0.727 (0.593, 0.861), 0.657 (0.504, 0.810) and 0.685 (0.543, 0.826), respectively, with statistical significance (P=0.001, 0.004, 0.047 and 0.020, respectively). The sensitivity of combination of CA19-9 and adiponectin in the diagnosis of PDAC complicated with DM was 0.917 and the negative predictive value was 0.940. The leptin level in advanced PDAC patients was lower than that in non advanced PDAC patients (0.61 μg /L, 0.11 μg /L to 2.28 μg /L vs 1.86 μg /L, 0.79 μg /L to 4.14 μg /L); and the difference was statistically significant (Z=-2.210, P=0.027). Higher serum adiponectin level was correlated with early recurrence after operation in PDAC patients complicated with DM (P=0.035).

Serum adipokines may be valuable in screening PDAC in patients with DM. And adipokines may be valuable in the prediction of recurrence after operation in PDAC patients complicated with DM.

Adipokines; Pancreatic neoplasms; Diabetes mellitus; Biological markers