Li Jingtao, Liu Jixi, Gao Chun, Liu Fang, Zhao Hongchuan
Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China.
Oncotarget. 2017 Aug 4;8(37):62478-62488. doi: 10.18632/oncotarget.19923. eCollection 2017 Sep 22.
Although the preexisting diabetes mellitus (DM) is known to have a high risk for death in many cancers, its impact on the mortality for the colorectal cancer (CRC) patients is still uncertain. In this study, we conducted a meta-analysis to explore an association of DM with the survival for the CRC patients.
We made a relative data search from the public available databases including Medline and Embase with a cutoff date to Jan 31, 2017. Pooled hazard ratios (HRs) were calculated using either a fixed or random effect model. Trim and fill analysis was conducted to test and adjust for publication bias. Subgroup analyses were also performed for overall survival and all-cause mortality when stratified by tumor stage, geographical region, duration of follow-up, gender and subsite of cancer.
Twenty-one eligible cohorts including 1,025,034 patients were identified and included in this meta-analysis review. The sample size for each analysis was ranged from 207 to 771,297 patients. It is revealed that with the preexisting DM, the CRC patients had a significantly increased all-cause mortality (pooled adjusted HR: 1.23; 95% CI: 1.11, 1.37) and decreased overall survival (pooled adjusted HR: 1.25, 95% CI: 1.19-1.31). But no difference was found for adjusted cancer-specific survival for the CRC patients with the preexisting DM compared with subjects without DM. These associations almost remained consistent after trim and fill adjustment and across those outcomes when stratified by site of cancer, tumor stage, population geography, study design, duration of follow-up, data resource or gender.
This meta-analysis review indicates that preexisting diabetes mellitus in CRC patients is severely associated with the worse overall survival but not with cancer-specific survival.
尽管已知既往糖尿病（DM）在许多癌症中具有较高的死亡风险，但其对结直肠癌（CRC）患者死亡率的影响仍不确定。在本研究中，我们进行了一项荟萃分析，以探讨DM与CRC患者生存率之间的关联。
我们从包括Medline和Embase在内的公共可用数据库中进行了相关数据检索，截止日期为2017年1月31日。使用固定或随机效应模型计算合并风险比（HRs）。进行了修剪和填充分析以检验和调整发表偏倚。还根据肿瘤分期、地理区域、随访时间、性别和癌症亚部位对总生存和全因死亡率进行了亚组分析。
确定了21个符合条件的队列，包括1,025,034例患者，并纳入了本荟萃分析综述。每次分析的样本量范围为207至771,297例患者。结果显示，患有既往DM的CRC患者全因死亡率显著增加（合并调整后HR：1.23；95%CI：1.11，1.37），总生存率降低（合并调整后HR：1.25，95%CI：1.19 - 1.31）。但与无DM的受试者相比，患有既往DM的CRC患者调整后的癌症特异性生存率没有差异。在进行修剪和填充调整后，以及在按癌症部位、肿瘤分期、人群地理、研究设计、随访时间、数据来源或性别分层的那些结果中，这些关联几乎保持一致。
本荟萃分析综述表明，CRC患者中既往糖尿病与较差的总生存率密切相关，但与癌症特异性生存率无关。
