***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose : Accumulating evidence suggests that metformin has antitumor activity . The aim of this study was to determine whether metformin use has a survival benefit in patients with pancreatic cancer . Experimental Design : We conducted a retrospective study of patients with diabetes and pancreatic cancer treated at The University of Texas MD And erson Cancer Center ( Houston , TX ) . Information on diabetes history , including treatment modalities and clinical outcome of pancreatic cancer , was collected using personal interviews and medical record review . Survival analysis was carried out using a Kaplan – Meier plot , log-rank test , and Cox proportional hazards regression models . Results : Among the 302 patients identified , there were no significant differences in demographic or major clinical characteristics between the patients who had received  metformin  ( n = 117 ) and those who had not ( n = 185 ) . The 2-year survival rate was 30.1 % for the metformin group and 15.4 % for the non-metformin group ( P = 0.004 ; χ2 test ) . The median overall survival time was 15.2 months for the metformin group , and 11.1 months for the non-metformin group ( P = 0.004 , log-rank test ) . Metformin users had a 32 % lower risk of death ; the HR ( 95 % confidence interval ) was 0.68 ( 0.52–0.89 ) in a univariate model ( P = 0.004 ) , 0.64 ( 0.48–0.86 ) after adjusting for other clinical predictors ( P = 0.003 ) , and 0.62 ( 0.44–0.87 ) after excluding insulin users ( P = 0.006 ) . Metformin use was significantly associated with longer survival in patients with nonmetastatic disease only . Conclusions : Our finding that metformin use was associated with improved outcome of patients with diabetes and pancreatic cancer should be confirmed in independent studies . Future research should prospect ively evaluate metformin as a supplemental therapy in this population . Clin Cancer Res ; 18(10 ) ; 2905–12 . © 2012 AACR Purpose To assess clinicopathologic features and postresection survival of diabetes mellitus (DM)-associated pancreatic ductal adenocarcinoma ( PDAC ) . Methods Records of resected PDAC patients from 2000 to 2007 were review ed . DM was classified as new-onset ( < 24 months before PDAC ) or longst and ing ( ≥24 months ) . Clinicopathologic features were compared by univariate and multivariate analyses . Survival was assessed by Kaplan – Meier method and Cox regression . Results Of 209 patients , 93 ( 45 % ) met criteria for DM ( 35 longst and ing DM , 55 new-onset DM , 3 duration unknown ) . DM patients were older ( DM 66 ± 9 years , non-DM 63 ± 12 years , P = 0.06 ) ; a majority had additional preoperative comorbidities ( DM 64.5 % , non-DM 25.9 % , P < 0.001 ) . Tumor size was larger in patients with DM ( DM 3.8 ± 1.7 cm , non-DM 3.2 ± 1.5 cm , P = 0.003 ) . Groups were similar in terms of tumor location , perineural/lymphovascular invasion , and node and margin status . On logistic regression , tumor size ≥3.0 cm was independently associated with both overall DM ( odds ratio [ OR ] 3.60 ; 95 % confidence interval [ 1.79–7.26 ] ) and new-onset DM ( OR 3.69 , [ 1.65–8.24 ] ) . Median survival was reduced in patients with DM compared with non-DM ( 15 versus 17 months , P = 0.015 ) . Multivariate analysis controlling for prognostic variables including age , comorbidities , and tumor size demonstrated that DM was independently associated with reduced survival ( hazard ratio [ HR ] 1.55 , [ 1.02–2.35 ] ) . This association was more pronounced for patients with new-onset DM ( HR 1.75 [ 1.10–2.78 ] ) than those with longst and ing DM ( HR 1.30 [ 0.75–2.25 ] ) . Conclusions Preexisting DM is associated with reduced survival in patients undergoing resection for PDAC . PDAC with new-onset DM may exhibit increased tumor size and decreased postresection survival . Additional investigation is needed to clarify etiology and impact of PDAC-associated DM BACKGROUND The aim of this study was to investigate prognostic factors of survival for patients with unresectable pancreatic cancer treated with nafamostat mesilate combined with gemcitabine chemotherapy .  PATIENTS AND METHODS The study included 41 patients who were diagnosed with unresectable pancreatic cancer and eligible for our clinical study of nafamostat mesilate , combined with gemcitabine chemotherapy for unresectable pancreatic cancer between February 2007 and November 2010 at Jikei University Hospital . We retrospectively investigated the relation between patients ' characteristics and overall survival using univariate and multivariate analyses . RESULTS In univariate analysis , absence of jaundice ( p=0.0365 ) , presence of ascites with or without histological diagnosis of carcinomatosis ( p=0.0042 ) , lymphocyte count ≥2,000/μl ( p=0.0088 ) , serum C-reactive protein ≥1 mg/dl ( p=0.014 ) , serum carcinoembryonic antigen ≥5 ng/ml ( p=0.0064 ) and serum CA19 - 9 ≥500 U/ml ( p=0.0164 ) were significant predictors of poor overall survival . In multivariate analysis , absence of jaundice ( p=0.0057 ) , presence of ascites with or without histological diagnosis of carcinomatosis ( p=0.0326 ) , lymphocyte ≥2,000/μl ( p<0.0001 ) and CA19 - 9 ≥500 U/ml ( p=0.0198 ) were independent predictors . CONCLUSION Jaundice , ascites , high lymphocyte count and high serum CA19 - 9 levels are independent prognostic predictors for poor overall survival of patients with unresectable pancreatic cancer treated with nafamostat mesilate combined with gemcitabine chemotherapy Background : Diabetes is a risk factor for pancreatic cancer but its association with survival from pancreatic cancer is poorly understood . Our objective was to investigate the association of diabetes with survival among pancreatic cancer patients in a prospect i ve cohort-based study where diabetes history was ascertained before pancreatic cancer diagnosis . Methods : We evaluated survival by baseline ( 1993–2001 ) self-reported diabetes history ( n=62 ) among 504 participants that developed exocrine pancreatic cancer within the Prostate , Lung , Colorectal , and Ovarian ( PLCO ) Cancer Screening Trial .  Hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) for mortality were estimated using Cox proportional hazards model , adjusted for age , sex , body mass index , race , smoking , and tumour stage ( local , locally advanced , and metastatic ) . Results : The multivariable-adjusted HR for mortality comparing participants with diabetes to those without was 1.52 ( 95 % CI=1.14–2.04 , P-value < 0.01 ) . After excluding those diagnosed with pancreatic cancer within 3 years of study enrolment , HR for mortality among those with diabetes was 1.45 ( 95 % CI=1.06–2.00 , P-value=0.02 ) . Conclusions : Using prospect ively collected data , our findings indicate that diabetes is associated with worse survival among patients with pancreatic cancer Objective To assess the influence of resection margins on survival for patients with resected pancreatic cancer treated within the context of the adjuvant European Study Group for Pancreatic Cancer-1 ( ESPAC-1 ) study . Summary Background Data Pancreatic cancer is associated with a poor long-term survival rate of only 10 % to 15 % after resection . Patients with positive microscopic resection margins ( R1 ) have a worse survival , but it is not known how they fare in adjuvant studies . Methods ESPAC-1 , the largest r and omized adjuvant study of resectable pancreatic cancer ever performed , set out to look at the roles of chemoradiation and chemotherapy . R and omization was stratified prospect ively by resection margin status . Results Of 541 patients with a median follow-up of 10 months , 101 ( 19 % ) had R1 resections .  Resection margin status was confirmed as an influential prognostic factor , with a median survival of 10.9 months for R1 versus 16.9 months months for patients with R0 margins . Resection margin status remained an independent factor in a Cox proportional hazards model only in the absence of tumor grade and nodal status . There was a survival benefit for chemotherapy but not chemoradiation , irrespective of R0/R1 status . The median survival was 19.7 months with chemotherapy versus 14.0 months without . For patients with R0 margins , chemotherapy produced longer survival compared with to no chemotherapy . This difference was less apparent for the smaller subgroup of R1 patients , but there was no significant heterogeneity between the R0 and R1 groups . Conclusions Resection margin-positive pancreatic tumors represent a biologically more aggressive cancer ; these patients benefit from resection and adjuvant chemotherapy but not chemoradiation . The magnitude of benefit for chemotherapy treatment is reduced for patients with R1 margins versus those with R0 margins . Patients with R1 tumors should be included in future trials of adjuvant treatments and r and omization and analysis should be stratified by this significant prognostic factor OBJECTIVE To analyze the  morbidity and mortality after radical and palliative pancreatic cancer surgery in Norway , especially the risk factors . SUMMARY BACKGROUND DATA A prospect i ve multicenter study between 1984 - 1987 including only histologically or cytologically verified adenocarcinoma of the pancreas ( N = 442 ) or the papilla of Vater ( N = 30 ) ; 84 patients ( 19 % ) with pancreatic carcinoma and 24 patients ( 80 % ) with papilla carcinoma underwent radical operations .  A palliative procedure was performed in 252 patients ( 53 % ) . METHODS Clinical data , surgical procedures and the following morbidity and mortality were recorded on st and ardized forms . The risk factors were analyzed by a logistic multiple regression model . RESULTS The morbidity , reoperation , and mortality rates were 43 , 18 , and 11 % after radical surgery and 23 , 4 , and 14 % after palliative surgery .  Karnofsky 's index was the sole independent risk factor for death after radical surgery .  Splenectomy , age , and TNM stage influenced morbidity . Diabetes , Karnofsky 's index , and liver metastases were risk factors in palliative surgery . CONCLUSIONS The morbidity and mortality risks were comparable between total pancreatectomy and a Whipple 's procedure and between biliary and a double bypass . Preoperative biliary drainage had no impact on the risks and may be ab and oned . High age is a relative and a low Karnofsky 's index an absolute contraindication for radical surgery . Nonsurgical palliation of jaundice should be considered according to the presence of independent risk factors BACKGROUND The relationship between prognosis of advanced pancreatic cancer and exocrine secretion impairment is unknown . AIM To investigate a possible correlation between faecal elastase-1 value and survival in advanced pancreatic cancer . METHODS 194 patients with advanced pancreatic cancer were prospect ively enrolled between 2007 and 2009 and underwent faecal elastase-1 measurement . Exocrine pancreatic secretion was defined as " moderately reduced " ( faecal elastase-1 : 100 - 200 μg/g ) , " severely reduced " ( faecal elastase-1<100 and > 20 μg/g ) and " extremely reduced " ( faecal elastase-1≤20 μg/g ) . RESULTS Median faecal elastase-1 was 204 μg/g ( interquartile range 19 ; 489 ) . Overall , 48 patients ( 25 % ) had an extremely reduced exocrine pancreatic secretion , 28 ( 14 % ) a severely reduced exocrine pancreatic secretion and 21 ( 11 % ) a moderately reduced exocrine pancreatic secretion . Patients with extremely reduced exocrine pancreatic secretion had higher rates of pancreatic head localizations ( P<0.01 ) and of jaundice ( P<0.01 ) . Median overall survival was 10.5 months . Patients with faecal elastase-1≤20 μg/g had a worse prognosis ( median survival : 7 versus 11 months , P=0.031 ) . Presence of metastases ( Hazard ratio 
    Output:
    
Diabetes was associated with higher mortality overall in patients with pancreatic cancer .
The effect of diabetes on overall survival was associated with the stages of tumor and the duration of diabetes