Boursi Ben, Giantonio Bruce J, Lewis James D, Haynes Kevin, Mamtani Ronac, Yang Yu-Xiao
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA; Tel-Aviv University, Tel-Aviv, Israel.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
Eur J Cancer. 2016 May;59:90-98. doi: 10.1016/j.ejca.2016.02.018. Epub 2016 Mar 25.
Despite the lack of scientific data, many cancer patients hold the belief that glucose 'feeds' cancer and might affect disease outcome. We aimed to evaluate associations between glucose, hemoglobin A1C (HbA1C), and survival among individuals with diabetes and diabetes associated cancers.
Five retrospective cohort studies were conducted in a large population-representative database. The study population included all patients with diabetes and an incident diagnosis of colorectal, breast, bladder, pancreatic and prostate cancers. Exposure of interest was serum glucose or HbA1C levels within 6 months prior to cancer diagnosis. Cox regression model was used to calculate hazard-ratio (HR) and 95% confidence-interval (CI) for overall survival. Analyses were adjusted for cancer-specific confounders. A subgroup analysis was performed among insulin-treated patients.
Study cohorts included 7916 individuals with incident cancers and concurrent diabetes. There was no association between HbA1C levels and overall survival in colorectal (HR 1.00, 95% CI 0.95-1.06), breast (HR 1.03, 95% CI 0.95-1.11), bladder (HR 0.94, 95% CI 0.86-1.01), pancreatic (HR 0.98, 95% CI 0.94-1.02), or prostate (HR 1.02, 95% CI 0.96-1.08) cancers. Among diabetes patients treated with insulin, there was increased survival with increasing serum glucose, most prominent for bladder cancer (HR 0.91, 95% CI 0.84-0.99, per 1 mmol/l increase).
Higher glucose and HbA1C levels in diabetes patients with incident cancer are not associated with worse overall survival following cancer diagnosis. Among insulin-treated patients, higher glucose levels may be associated with improved survival.
尽管缺乏科学数据，但许多癌症患者认为葡萄糖会“滋养”癌症，并可能影响疾病预后。我们旨在评估糖尿病及糖尿病相关癌症患者中葡萄糖、糖化血红蛋白（HbA1C）与生存率之间的关联。
在一个具有大型人群代表性的数据库中进行了五项回顾性队列研究。研究人群包括所有糖尿病患者以及新诊断为结直肠癌、乳腺癌、膀胱癌、胰腺癌和前列腺癌的患者。感兴趣的暴露因素为癌症诊断前6个月内的血清葡萄糖或HbA1C水平。采用Cox回归模型计算总生存的风险比（HR）和95%置信区间（CI）。分析针对癌症特异性混杂因素进行了校正。对接受胰岛素治疗的患者进行了亚组分析。
研究队列包括7916例新发癌症且同时患有糖尿病的患者。在结直肠癌（HR 1.00，95%CI 0.95 - 1.06）、乳腺癌（HR 1.03，95%CI 0.95 - 1.11）、膀胱癌（HR 0.94，95%CI 0.86 - 1.01）、胰腺癌（HR 0.98，95%CI 0.94 - 1.02）或前列腺癌（HR 1.02，95%CI 0.96 - 1.08）中，HbA1C水平与总生存之间均无关联。在接受胰岛素治疗的糖尿病患者中，血清葡萄糖水平升高与生存率增加相关，在膀胱癌中最为显著（每升高1 mmol/l，HR 0.91，95%CI 0.84 - 0.99）。
新发癌症的糖尿病患者中较高的葡萄糖和HbA1C水平与癌症诊断后的总生存较差无关。在接受胰岛素治疗的患者中，较高的葡萄糖水平可能与生存率改善相关。
