Wang Mina, Yang Yingying, Liao Zehuan
School of Biological Sciences, Nanyang Technological University, Singapore 637551, Singapore.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna 17177, Sweden.
World J Diabetes. 2020 Jun 15;11(6):227-238. doi: 10.4239/wjd.v11.i6.227.
The incidence of diabetes and cancer has increased significantly in recent years. Furthermore, there are many common risk factors for both diabetes and cancer, such as obesity, sedentary lifestyle, smoking, and ageing. A large body of epidemiological evidence has indicated that diabetes is considered as an independent risk factor for increased rates of heterogeneous types of cancer occurrence and death. The incidence and mortality of various types of cancer, such as pancreas, liver, colorectal, breast, endometrial, and bladder cancers, have a modest growth in diabetics. However, diabetes may work as a protective factor for prostate cancer. Although the underlying biological mechanisms have not been totally understood, studies have validated that insulin/insulin-like growth factor (IGF) axis (including insulin resistance, hyperinsulinemia, and IGF), hyperglycemia, inflammatory cytokines, and sex hormones provide good circumstances for cancer cell proliferation and metastasis. Insulin/IGF axis activates several metabolic and mitogenic signaling pathways; hyperglycemia provides energy for cancer cell growth; inflammatory cytokines influence cancer cell apoptosis. Thus, these three factors affect all types of cancer, while sex hormones only play important roles in breast cancer, endometrial cancer, and prostate cancer. This minireview consolidates and discusses the epidemiological and biological links between diabetes and various types of cancer.
近年来，糖尿病和癌症的发病率显著上升。此外，糖尿病和癌症有许多共同的风险因素，如肥胖、久坐不动的生活方式、吸烟和衰老。大量的流行病学证据表明，糖尿病被认为是导致不同类型癌症发生率和死亡率上升的独立风险因素。糖尿病患者中，胰腺癌、肝癌、结直肠癌、乳腺癌、子宫内膜癌和膀胱癌等各类癌症的发病率和死亡率有适度增长。然而，糖尿病可能对前列腺癌起到保护作用。尽管其潜在的生物学机制尚未完全明确，但研究证实胰岛素/胰岛素样生长因子（IGF）轴（包括胰岛素抵抗、高胰岛素血症和IGF）、高血糖、炎性细胞因子和性激素为癌细胞增殖和转移提供了有利条件。胰岛素/IGF轴激活多种代谢和促有丝分裂信号通路；高血糖为癌细胞生长提供能量；炎性细胞因子影响癌细胞凋亡。因此，这三个因素影响所有类型的癌症，而性激素仅在乳腺癌、子宫内膜癌和前列腺癌中起重要作用。本综述总结并讨论了糖尿病与各类癌症之间的流行病学和生物学联系。
