Division of Hematology Oncology, Mayo Clinic Scottsdale, Scottsdale, Arizona 85259, USA.
Endocr Pract. 2012 Nov-Dec;18(6):898-905. doi: 10.4158/EP12128.OR.
To determine the prevalence of diabetes mellitus, glycemic control, and impact of diabetes on overall survival in an academic oncology practice.
Data on cancer patients (1999 to 2008) were retrieved from the institutional cancer registry and linked to electronic files to obtain diabetes status and hemoglobin A1c (A1C) values within the first 6 months of cancer diagnosis. Overall survival by cancer type with and without diabetes was compared using Cox regression.
Excluding skin and hematologic malignancies, 15,951 cancer cases were identified. Overall diabetes prevalence was 6.8% (n = 1,090), declining over time (P<0.001). Diabetes was common among patients with pancreatic (9.8% [61 of 624]), colorectal (7.7% [89 of 1,151]), or bladder cancers (7.6% [68 of 899]). Patients with diabetes were older (mean age, 70 versus 66 years; P<0.001) and more likely to be male (66.3% [723 of 1,090] versus 60.2% [8,949 of 14,858]; P<0.001). The mean A1C among diabetic cancer patients was 6.8% and did not differ across cancer types (P = 0.80). Only 58.6% (331 of 565) of diabetic cancer patients had all A1C <7.0% during the first 6 months following cancer diagnosis. Pancreatic cancer patients with coexisting diabetes had better overall survival than pancreatic cancer patients without diabetes (hazard ratio, 0.60; 95% confidence interval 0.44 to 0.80; P<0.001). Conversely, diabetic prostate cancer patients had worse overall survival than prostate cancer patients without diabetes (hazard ratio, 1.36; 95% confidence interval 1.05 to 1.76; P = 0.02).
In this academic oncology practice, diabetes was common, glycemic control often was suboptimal, and survival varied by cancer type. Additional study is needed to optimize glucose management and investigate mechanisms underlying age, sex, and survival differences.
在学术肿瘤学实践中，确定糖尿病的患病率、血糖控制情况以及糖尿病对总生存率的影响。
从机构癌症登记处检索了 1999 年至 2008 年癌症患者的数据，并与电子文件相关联，以获取癌症诊断后 6 个月内的糖尿病状态和血红蛋白 A1c（A1C）值。使用 Cox 回归比较有和无糖尿病的癌症类型的总生存率。
排除皮肤和血液恶性肿瘤后，确定了 15951 例癌症病例。总体糖尿病患病率为 6.8%（n=1090），呈下降趋势（P<0.001）。患有胰腺癌（9.8%[61/624]）、结直肠癌（7.7%[89/1151]）或膀胱癌（7.6%[68/899]）的患者中糖尿病更为常见。患有糖尿病的患者年龄更大（平均年龄为 70 岁 vs 66 岁；P<0.001），且更可能为男性（66.3%[723/1090] vs 60.2%[8，8949/14858]；P<0.001）。糖尿病癌症患者的平均 A1C 为 6.8%，且不同癌症类型之间无差异（P=0.80）。仅有 58.6%（331/565）的患有糖尿病的癌症患者在癌症诊断后 6 个月内所有 A1C<7.0%。患有合并糖尿病的胰腺癌患者的总体生存率优于没有糖尿病的胰腺癌患者（风险比，0.60；95%置信区间 0.44 至 0.80；P<0.001）。相反，患有糖尿病的前列腺癌患者的总体生存率差于没有糖尿病的前列腺癌患者（风险比，1.36；95%置信区间 1.05 至 1.76；P=0.02）。
在该学术肿瘤学实践中，糖尿病很常见，血糖控制通常不理想，且生存率因癌症类型而异。需要进一步研究以优化葡萄糖管理，并探讨年龄、性别和生存率差异的潜在机制。
