Iwase Masanori, Fujii Hiroki, Idewaki Yasuhiro, Nakamura Udai, Ohkuma Toshiaki, Ide Hitoshi, Komorita Yuji, Jodai-Kitamura Tamaki, Yoshinari Masahito, Kitazono Takanari
1Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582 Japan.
Diabetes Center and Clinical Research Center, Hakujyuji Hospital, Fukuoka, Japan.
Diabetol Int. 2019 Feb 20;10(4):260-267. doi: 10.1007/s13340-019-00390-0. eCollection 2019 Oct.
Although the association between type 2 diabetes and cancer has been reported, few epidemiological studies have been conducted in Japanese patients whose leading cause of death is cancer. We prospectively studied the incidence of site-specific cancer, risk factors for developing cancer, cancer death, and survival in Japanese patients with type 2 diabetes.
We followed 4923 participants (mean age, 65 years) with type 2 diabetes attending an outpatient diabetes clinic for a median of 5.3 years (follow-up rate, 99.0%).
During the follow-up period, cancer occurred in 450 participants (incidence rate, 22.3/1000 person-years in men and 12.2/1000 person-years in women). In men, prostate cancer was the most common cancer (4.3/1000 person-years), colorectal cancer was the second (3.6/1000 person-years), and gastric cancer was the third (3.3/1000 person-years). In women, colorectal cancer was the most common cancer (2.6/1000 person-years), gastric cancer was the second (2.0/1000 person-years), and breast cancer was the third (1.4/1000 person-years). Smoking, male sex, low-density lipoprotein cholesterol, family history of cancer, and reduced intake of isoflavone daidzein were significant risk factors for developing cancer using multivariable Cox proportional hazards models. The leading cancer death was lung cancer in men and pancreatic cancer in women. The survival was the best for prostate cancer and the worst for pancreatic cancer (2-year cancer-specific survival 95.4%, 30.0%, respectively).
Since the leading cause of death in patients with type 2 diabetes is cancer in Japan, clinicians should be aware of epidemiological data regarding cancer besides diabetic complications.
尽管已有报道称2型糖尿病与癌症之间存在关联，但针对主要死因是癌症的日本患者开展的流行病学研究较少。我们对日本2型糖尿病患者特定部位癌症的发病率、患癌风险因素、癌症死亡情况及生存率进行了前瞻性研究。
我们对4923名2型糖尿病门诊患者（平均年龄65岁）进行了随访，中位随访时间为5.3年（随访率99.0%）。
在随访期间，450名参与者患癌（发病率：男性为22.3/1000人年，女性为12.2/1000人年）。在男性中，前列腺癌是最常见的癌症（4.3/1000人年），其次是结直肠癌（3.6/1000人年），胃癌位居第三（3.3/1000人年）。在女性中，结直肠癌是最常见的癌症（2.6/1000人年），其次是胃癌（2.0/1000人年），乳腺癌位居第三（1.4/1000人年）。使用多变量Cox比例风险模型分析得出，吸烟、男性、低密度脂蛋白胆固醇、癌症家族史以及异黄酮大豆苷元摄入量减少是患癌的显著风险因素。主要的癌症死亡原因在男性中是肺癌，在女性中是胰腺癌。前列腺癌患者的生存率最佳，胰腺癌患者的生存率最差（2年癌症特异性生存率分别为95.4%和30.0%）。
在日本，2型糖尿病患者的主要死因是癌症，因此临床医生除了关注糖尿病并发症外，还应了解有关癌症的流行病学数据。
