Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy.
J Cancer Res Clin Oncol. 2013 Aug;139(8):1303-10. doi: 10.1007/s00432-013-1439-8. Epub 2013 Apr 30.
Diabetes is associated with increased risk of developing colorectal cancer (CRC), but its effect on overall and cancer-specific mortality in CRC patients has been little investigated. The aim of this study was to assess the influence of diabetes on overall and cancer-specific mortality in Italian CRC patients.
Cases of adult (≥15 years) CRC, diagnosed in 2003-2005, most followed-up to the end of 2008, were randomly selected from the Italian Cancer Registries database. Diabetic status, sex, age, tumor stage, subsite, treatment, morphology, and grade were obtained by consultation of patient clinical records. Poisson multivariable regression models, adjusted for potential confounding variables, were used to estimate hazard ratios (HRs) for all-cause and CRC-specific mortality, according to diabetic status.
A total of 1,039 CRC cases with known fasting glucose or diabetic status, archived in 7 cancer registries, was analyzed. Compared to non-diabetics, diabetics (specific diagnosis or glucose ≥126 mg/dl) were older and less likely to receive adjuvant therapy. Diabetics were at higher risk of all-cause death [HR 1.41; 95 % confidence interval (CI) 1.18-1.70] and CRC death (HR 1.36; 95 % CI 1.11-1.67), with no differences by sex or subsite.
Diabetes was significantly associated with increased overall and CRC-specific mortality. Our findings indicate that diabetes is a negative prognostic factor for CRC and suggest that in patients with CRC, diabetes prevention and treatments that stabilize the condition and control its complications might reduce mortality. Further studies are required to ascertain the mechanisms linking diabetes to greater mortality in CRC patients.
糖尿病与结直肠癌（CRC）风险增加相关，但糖尿病对 CRC 患者总体生存率和癌症特异性生存率的影响尚未得到充分研究。本研究旨在评估糖尿病对意大利 CRC 患者总体生存率和癌症特异性生存率的影响。
从意大利癌症登记数据库中随机选择 2003-2005 年诊断的成年（≥15 岁）CRC 病例，大多数随访至 2008 年底。通过查阅患者临床记录获得糖尿病状态、性别、年龄、肿瘤分期、部位、治疗、形态和分级等信息。使用泊松多变量回归模型，根据糖尿病状态调整潜在混杂因素，估计全因死亡率和 CRC 特异性死亡率的危险比（HR）。
共分析了 7 个癌症登记处的 1,039 例已知空腹血糖或糖尿病状态的 CRC 病例。与非糖尿病患者相比，糖尿病患者（明确诊断或血糖≥126mg/dl）年龄更大，更不可能接受辅助治疗。糖尿病患者全因死亡风险更高[HR 1.41；95%置信区间（CI）1.18-1.70]和 CRC 死亡风险[HR 1.36；95% CI 1.11-1.67]，但性别或部位无差异。
糖尿病与总体生存率和 CRC 特异性生存率显著相关。我们的研究结果表明，糖尿病是 CRC 的一个负性预后因素，并提示在 CRC 患者中，预防糖尿病和治疗稳定病情并控制其并发症可能会降低死亡率。需要进一步的研究来确定糖尿病与 CRC 患者更高死亡率之间的机制。
