Admission Glucose and Presenting Symptoms in Relation to Disease Stage in Newly Diagnosed Pancreatic Ductal Adenocarcinoma.

Background/Objectives: Pancreatic ductal adenocarcinoma (PDAC) carries the poorest prognosis among gastrointestinal malignancies, largely owing to diagnosis at an advanced stage. Hyperglycaemia and new-onset diabetes are increasingly recognised as early manifestations of PDAC, yet long-standing type 2 diabetes is also an established risk factor. Whether admission plasma glucose, together with presenting symptoms, are associated with disease stage at diagnosis remain poorly characterised. We examined the association of admission glucose and presenting symptoms with disease stage in newly diagnosed PDAC. Methods: We performed a retrospective, single-centre analysis of 114 consecutive patients with histologically confirmed PDAC and both recorded admission plasma glucose and imaging-confirmed stage. Random admission plasma glucose, diabetes status, and presenting symptoms were extracted from electronic medical records. Symptoms were categorised as jaundice, abdominal pain, weight loss, or incidental (asymptomatic) detection. Disease stage was classified as metastatic (M1) or non-metastatic (M0) on the basis of imaging at diagnosis. Groups were compared using the Mann-Whitney U test and the χ2 test with continuity correction; multivariable logistic regression and receiver operating characteristic (ROC) analysis were performed. Results: The cohort comprised 60 women (52.6%) and 54 men (47.4%); 49 patients (43.0%) had metastatic and 65 (57.0%) had non-metastatic disease. Median age at diagnosis was 68 years (range 27-88). Diabetes was present in 40.4% (46/114), predominantly type 2 (87%), and did not differ by stage (42.9% vs. 38.5%; p = 0.78). Jaundice was more frequent in metastatic than non-metastatic disease (59.2% vs. 38.5%; χ2 = 4.02, p = 0.045), whereas abdominal pain (53.1% vs. 36.9%; p = 0.13) and weight loss (24.5% vs. 33.8%; p = 0.38) did not differ significantly. Mean admission glucose was 145.5 ± 59.8 mg/dL and was higher in patients with than without diabetes (178.6 ± 68.7 vs. 123.2 ± 40.1 mg/dL; p < 0.0001). Glucose analysed continuously did not differ by stage (148.4 vs. 143.3 mg/dL; p = 0.29), whereas hyperglycaemia ≥ 126 mg/dL was more frequent in metastatic disease (63.3% [95% CI 49.3-75.3] vs. 41.5% [95% CI 30.4-53.7]; χ2 = 4.44, p = 0.035; odds ratio 2.42, 95% CI 1.13-5.19). In multivariable logistic regression adjusting for age, sex, and diabetes, hyperglycaemia remained independently associated with metastatic stage (adjusted odds ratio 2.59, 95% CI 1.13-5.95; p = 0.025). However, discrimination was poor: the area under the ROC curve for admission glucose was 0.56 (95% CI 0.45-0.66). Among jaundiced patients, admission glucose did not differ significantly by stage (162.8 vs. 152.8 mg/dL; p = 0.41). Conclusions: In this retrospective, single-centre cohort, jaundice at presentation and admission hyperglycaemia ≥ 126 mg/dL were each associated with metastatic stage, and hyperglycaemia remained associated after adjustment. Nevertheless, the discriminative performance of admission glucose was poor, and these variables cannot be recommended for individual patient stratification. These hypothesis-generating findings require confirmation in larger, prospective, multicentre studies.