Grossman School of Medicine, New York University, New York, NY, 10016, USA.
Miller School of Medicine, University of Miami, Miami, FL, USA.
Int J Colorectal Dis. 2020 Nov;35(11):1989-1999. doi: 10.1007/s00384-020-03666-z. Epub 2020 Jun 20.
The impact of diabetes mellitus (DM) on colorectal cancer (CRC) outcomes remains unknown. We studied this by conducting a meta-analysis to evaluate (1) CRC outcomes with and without DM and (2) treatment patterns.
We searched PubMed, EMBASE, Google Scholar, and CINAHL for full-text English studies from 1970 to 12/31/2017. We searched keywords, subject headings, and MESH terms to locate studies of CRC outcomes/treatment and DM. Studies were evaluated by two oncologists. Of 14,332, 48 met inclusion criteria. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method, we extracted study location, design, DM definition, covariates, comparison groups, outcomes, and relative risks and/or hazard ratios. We utilized a random-effects model to pool adjusted risk estimates. Primary outcomes were all-cause mortality (ACM), disease-free survival (DFS), relapse-free survival (RFS), and cancer-specific survival (CSS). The secondary outcome was treatment patterns.
Forty-eight studies were included, 42 in the meta-analysis, and 6 in the descriptive analysis, totaling > 240,000 patients. ACM was 21% worse (OR 1.21, 95% CI 1.15-1.28) and DFS was 75% worse (OR 1.75, 95% CI: 1.33-2.31) in patients with DM. No differences were detected in CSS (OR 1.10, 95% CI 0.98-1.23) or RFS (OR 1.12, 95% CI 0.91-1.38). Descriptive analysis of treatment patterns in CRC and DM suggested potentially less adjuvant therapy use in cases with DM and CRC.
Our meta-analysis suggests that patients with CRC and DM have worse ACM and DFS than patients without DM, suggesting that non-cancer causes of death in may account for worse outcomes.
糖尿病（DM）对结直肠癌（CRC）结局的影响尚不清楚。我们通过进行荟萃分析来研究这一点，以评估（1）有和没有 DM 的 CRC 结局，以及（2）治疗模式。
我们在 1970 年至 2017 年 12 月 31 日期间从 PubMed、EMBASE、Google Scholar 和 CINAHL 中搜索了全文英文研究。我们搜索了关键词、主题词和 MESH 术语，以找到 CRC 结局/治疗和 DM 的研究。由两名肿瘤学家评估研究。在 14332 篇中，有 48 篇符合纳入标准。根据系统评价和荟萃分析的首选报告项目方法，我们提取了研究地点、设计、DM 定义、协变量、对照组、结局和相对风险和/或风险比。我们使用随机效应模型对调整后的风险估计值进行汇总。主要结局是全因死亡率（ACM）、无病生存率（DFS）、无复发生存率（RFS）和癌症特异性生存率（CSS）。次要结局是治疗模式。
共纳入 48 项研究，其中 42 项进行荟萃分析，6 项进行描述性分析，共纳入超过 240000 例患者。患有 DM 的患者的 ACM 差 21%（OR 1.21，95%CI 1.15-1.28），DFS 差 75%（OR 1.75，95%CI：1.33-2.31）。在 CSS（OR 1.10，95%CI 0.98-1.23）或 RFS（OR 1.12，95%CI 0.91-1.38）方面未发现差异。CRC 和 DM 治疗模式的描述性分析表明，患有 DM 和 CRC 的患者可能较少使用辅助治疗。
我们的荟萃分析表明，患有 CRC 和 DM 的患者的 ACM 和 DFS 比没有 DM 的患者差，这表明非癌症原因的死亡可能导致结局更差。
