Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Ann Arbor, MI, USA.
Gynecol Oncol. 2011 Apr;121(1):106-11. doi: 10.1016/j.ygyno.2010.12.329. Epub 2011 Jan 13.
Diabetes is increasingly common among cancer patients and plausible biologic mechanisms exist by which diabetes may influence cancer prognosis. We aimed to investigate the impact of diabetes on ovarian cancer outcomes.
We assessed the outcomes of 570 non-diabetic and 72 diabetic patients with epithelial ovarian, fallopian tube, and primary peritoneal cancer over a ten-year period. All inpatient and outpatient records were reviewed. The primary end points were overall and disease-free survival.
Of the 642 cases, 11.2% had type II diabetes. Diabetics were more likely to be older, had a higher BMI (33.4 vs. 27.8), and had more comorbid conditions. Diabetics were less likely to have been surgically staged as compared to non-diabetics (p=0.04) although stage, grade, and likelihood of optimal cytoreduction were similar between groups. Over a period of 10 years, with an average of 44 months of follow-up, the median overall survival for diabetics was 1503 days. The median overall survival for non-diabetics was 2464 days (log rank test, p=0.02). In a Cox proportional hazards multivariable model, diabetes remained a significant predictor of overall survival (HR=2.04, p<0.01).
Diabetics with ovarian cancer demonstrate strikingly poorer survival. The underlying reason for this is yet unknown and deserves further attention. Differences in care, competing risks of death, and changes within the tumor biology are plausible mechanisms for the observed difference in survival.
癌症患者中糖尿病的发病率越来越高，并且存在合理的生物学机制表明糖尿病可能影响癌症的预后。我们旨在研究糖尿病对卵巢癌结局的影响。
我们评估了 570 名非糖尿病和 72 名患有上皮性卵巢癌、输卵管癌和原发性腹膜癌的糖尿病患者在十年期间的结局。回顾了所有住院和门诊记录。主要终点是总生存和无病生存。
在 642 例病例中，11.2%患有 2 型糖尿病。与非糖尿病患者相比，糖尿病患者年龄更大，BMI 更高（33.4 比 27.8），合并症更多。与非糖尿病患者相比，糖尿病患者接受手术分期的可能性较低（p=0.04），尽管两组的分期、分级和最佳肿瘤细胞减灭术的可能性相似。在 10 年的时间内，平均随访 44 个月，糖尿病患者的中位总生存时间为 1503 天。非糖尿病患者的中位总生存时间为 2464 天（对数秩检验，p=0.02）。在 Cox 比例风险多变量模型中，糖尿病仍然是总生存的显著预测因素（HR=2.04，p<0.01）。
患有卵巢癌的糖尿病患者的生存明显较差。其根本原因尚不清楚，值得进一步关注。护理方面的差异、死亡的竞争风险以及肿瘤生物学的变化是观察到的生存差异的合理机制。
