de Kort Sander, Simons C C J M, van den Brandt Piet A, Goldbohm R Alexandra Sandra, Arts Ilja C W, de Bruine Adriaan P, Janssen-Heijnen Maryska L G, Sanduleanu Silvia, Masclee Ad A M, Weijenberg Matty P
aDepartment of Epidemiology, GROW - School for Oncology and Developmental Biology, CAPHRI School for Public Health and Primary Care, and CARIM School for Cardiovascular Diseases Maastricht University bDepartment of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht cDepartment of Prevention and Health, TNO Quality of Life, Leiden Departments of dPathology eClinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands.
Eur J Gastroenterol Hepatol. 2016 Aug;28(8):896-903. doi: 10.1097/MEG.0000000000000626.
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of colorectal cancer (CRC); however, studies differentiating between subsites of CRC are limited. We investigated how diabetes mellitus (DM) was associated with subsite-specific CRC risk in men and women.
The Netherlands Cohort Study on diet and cancer is a prospective study among 120 852 men and women aged 55-69 years old at baseline in 1986. Information on DM, anthropometric, dietary and lifestyle factors was self-reported at baseline. T2DM was defined as the diagnosis of DM after 30 years of age. Incident CRC cases were identified by record linkage with the Netherlands cancer registry and the Dutch pathology registry. After 17.3 years of follow-up, 1735 incident male CRC cases and 1321 female CRC cases were available for analyses. Subsite-specific hazard ratios (HRs) for CRC were estimated in case-cohort analyses using Cox regression.
At baseline, 3.1% of subcohort members reported T2DM, of whom 80% were diagnosed after 50 years of age. Multivariable-adjusted models showed that the risk of proximal colon cancer was significantly increased in women with T2DM versus women without T2DM (HR=1.80, 95% confidence interval: 1.10-2.94). There was no association between T2DM and the risk of overall CRC, distal colon cancer and rectal cancer in women. In men, T2DM was not associated with overall CRC (HR=0.98, 95% confidence interval: 0.64-1.50), or with risk at any subsite.
This prospective study showed an increased risk of proximal colon cancer in women with T2DM compared with non-T2DM women.
2型糖尿病（T2DM）与结直肠癌（CRC）风险增加相关；然而，区分结直肠癌不同亚部位的研究有限。我们调查了糖尿病（DM）与男性和女性特定亚部位结直肠癌风险之间的关联。
荷兰饮食与癌症队列研究是一项针对1986年基线时年龄在55 - 69岁的120852名男性和女性的前瞻性研究。关于糖尿病、人体测量学参数、饮食和生活方式因素的信息在基线时通过自我报告获得。T2DM定义为30岁以后诊断的糖尿病。通过与荷兰癌症登记处和荷兰病理登记处的记录链接来识别新发结直肠癌病例。经过17.3年的随访，有1735例男性新发结直肠癌病例和1321例女性新发结直肠癌病例可供分析。在病例队列分析中使用Cox回归估计结直肠癌特定亚部位的风险比（HRs）。
在基线时，3.1%的队列成员报告患有T2DM，其中80%在50岁以后被诊断。多变量调整模型显示，患有T2DM的女性与未患T2DM的女性相比，近端结肠癌风险显著增加（HR = 1.80，95%置信区间：1.10 - 2.94）。T2DM与女性总体结直肠癌、远端结肠癌和直肠癌风险之间无关联。在男性中，T2DM与总体结直肠癌（HR = 0.98，95%置信区间：0.64 - 1.50）或任何亚部位的风险均无关联。
这项前瞻性研究表明，与非T2DM女性相比，患有T2DM的女性近端结肠癌风险增加。
