The Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
Cancer. 2013 Apr 15;119(8):1512-20. doi: 10.1002/cncr.27923. Epub 2012 Dec 20.
Although epidemiologic studies suggest that metabolic syndrome (MetS) increases the risk of colorectal cancer, its effect on cancer mortality remains controversial.
The authors used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (1998-2006) to conduct a retrospective cohort study of 36,079 patients with colon cancer to determine the independent effect of MetS and its components on overall survival (OS) and recurrence-free rates (RFRs). Data on MetS and its components were ascertained from Medicare claims. OS and RFRs in patients with and without MetS and its components were compared using multivariate Cox models.
MetS had no apparent effect on OS or RFR. Both elevated glucose/diabetes mellitus (DM) and elevated hypertension were associated with worse OS (adjusted hazard ratio [aHR], 1.17 [95% confidence interval, 1.13-1.21] and 1.08 [95% confidence interval, 1.03-1.12], respectively) and worse RFRs (aHR, 1.25 [95% confidence interval, 1.16-1.34] and 1.22 [95% confidence interval, 1.12-1.33], respectively). In contrast, dyslipidemia was associated with improved survival (aHR, 0.77; 95% confidence interval, 0.75-0.80) and reduced recurrence (aHR, 0.71; 95% confidence interval, 0.66-0.75). These effects were consistent for both men and women and were more pronounced in patients with early stage disease.
MetS had no apparent effect on colon cancer outcomes, probably because of the combined adverse effects of elevated glucose/DM and hypertension and the protective effect of dyslipidemia in patients with nonmetastatic disease. The authors concluded that patients who have early stage colon cancer with elevated glucose/DM and/or hypertension may benefit from more intensive surveillance and/or broader use of adjuvant therapy and that trials to define the benefits of low-fat diets, insulin-lowering agents, and statins on recurrence/survival in patients with nonmetastatic colon cancer are warranted.
尽管流行病学研究表明代谢综合征（MetS）会增加结直肠癌的风险，但它对癌症死亡率的影响仍存在争议。
作者使用监测、流行病学和最终结果（SEER）-医疗保险数据库（1998-2006 年）对 36079 例结肠癌患者进行回顾性队列研究，以确定 MetS 及其组成部分对总生存率（OS）和无复发生存率（RFR）的独立影响。MetS 及其组成部分的数据来自医疗保险索赔。使用多变量 Cox 模型比较 MetS 及其组成部分患者与无 MetS 及其组成部分患者的 OS 和 RFR。
MetS 对 OS 或 RFR 没有明显影响。升高的血糖/糖尿病（DM）和升高的高血压均与较差的 OS（调整后的危险比 [aHR]，1.17 [95%置信区间，1.13-1.21] 和 1.08 [95%置信区间，1.03-1.12]）和较差的 RFR（aHR，1.25 [95%置信区间，1.16-1.34] 和 1.22 [95%置信区间，1.12-1.33]）相关。相比之下，血脂异常与生存改善相关（aHR，0.77；95%置信区间，0.75-0.80）和复发减少（aHR，0.71；95%置信区间，0.66-0.75）。这些影响在男性和女性中均一致，并且在疾病早期患者中更为明显。
MetS 对结肠癌结局没有明显影响，可能是因为在非转移性疾病患者中，升高的血糖/糖尿病和高血压的联合不良影响以及血脂异常的保护作用所致。作者总结认为，患有早期结肠癌且血糖升高/糖尿病和/或高血压的患者可能受益于更密集的监测和/或更广泛地使用辅助治疗，并且有必要进行试验以确定低脂饮食、胰岛素降低剂和他汀类药物对非转移性结肠癌患者的复发/生存的益处。
