Griffiths Robert I, Valderas José M, McFadden Emily C, Bankhead Clare R, Lavery Bernadette A, Khan Nada F, Stevens Richard J, Keating Nancy L
Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, 21205, USA.
J Cancer Surviv. 2017 Oct;11(5):604-613. doi: 10.1007/s11764-017-0631-2. Epub 2017 Jul 22.
Preexisting diabetes is associated with increased morbidity and mortality in cancer. We examined the impact of incident cancer on the long-term outcomes of diabetes.
Using the United Kingdom Clinical Practice Research Datalink, we identified three cohorts of diabetes patients subsequently diagnosed with breast, colorectal, or prostate cancer, each matched to diabetic noncancer controls. Patients were required to have survived at least 1 year after cancer diagnosis (cases) or a matched index date (controls), and were followed up to 10 years for incident microvascular and macrovascular complications and mortality. Multivariate competing risks regression analyses were used to compare outcomes between cancer patients and controls.
Overall, there were 3382 cancer patients and 11,135 controls with 59,431 person-years of follow-up. In adjusted analyses, there were no statistically significant (p ≤ 0.05) differences in diabetes complication rates between cancer patients and their controls in any of the three cancer cohorts. Combined, cancer patients were less likely (adjusted hazard ratio [HR] 0.88; 95% CI = 0.79-0.98) to develop retinopathy. Cancer patients were more likely to die of any cause (including cancer), but prostate cancer patients were less likely to die of causes associated with diabetes (HR 0.61; 95% CI = 0.43-0.88).
There is no evidence that incident cancer had an adverse impact on the long-term outcomes of preexisting diabetes.
These findings are important for cancer survivors with preexisting diabetes because they suggest that substantial improvements in the relative survival of several of the most common types of cancer are not undermined by excess diabetes morbidity and mortality.
既往糖尿病与癌症患者更高的发病率和死亡率相关。我们研究了新发癌症对糖尿病长期预后的影响。
利用英国临床实践研究数据链，我们确定了三组糖尿病患者队列，这些患者随后被诊断患有乳腺癌、结直肠癌或前列腺癌，每组均与糖尿病非癌症对照匹配。患者在癌症诊断（病例组）或匹配的索引日期（对照组）后至少存活1年，并随访10年，观察微血管和大血管并发症的发生情况及死亡率。采用多变量竞争风险回归分析比较癌症患者与对照组的预后。
总体而言，有3382例癌症患者和11135例对照，共随访59431人年。在调整分析中，三个癌症队列中的任何一组，癌症患者与其对照组之间的糖尿病并发症发生率均无统计学显著差异（p≤0.05）。综合来看，癌症患者发生视网膜病变的可能性较小（调整后风险比[HR]0.88；95%置信区间=0.79-0.98）。癌症患者死于任何原因（包括癌症）的可能性更大，但前列腺癌患者死于与糖尿病相关原因的可能性较小（HR 0.61；95%置信区间=0.43-0.88）。
没有证据表明新发癌症对既往糖尿病的长期预后有不利影响。
这些发现对患有既往糖尿病的癌症幸存者很重要，因为它们表明几种最常见癌症类型的相对生存率的显著提高不会因糖尿病发病率和死亡率过高而受到影响。
