Leeds Institute for Data Analytics, Level 11, Worsley Building, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
Leeds Institute for Data Analytics, Level 11, Worsley Building, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
Eur J Surg Oncol. 2021 May;47(5):999-1004. doi: 10.1016/j.ejso.2020.10.033. Epub 2020 Nov 3.
Diabetes is considered a risk factor for mortality following a diagnosis of cancer. We hypothesised that the risk will vary due to the heterogeneous nature of the population and accurate classification of vascular complications will improve prediction of clinical outcomes.
The COloRECTal cancer data Repository (CORECT-R) was used to identify individuals with primary colorectal cancer, who underwent surgical resection in England (2005-2016). Diabetes was recorded using ICD10 codes (E10-E14) during inpatient hospital admission in the six years preceding cancer diagnosis, complication status was determined using the adapted Diabetes Complications Severity Index (aDCSI). Survival and post-operative outcomes were compared between groups.
Of 232,367 individuals, 28,642 (12.3%) were recorded as having diabetes, 49.2% of whom had complications according to the aDCSI. Patients with diabetes complications had increased incidence of adverse post-operative outcomes (90-day post-operative mortality (6.6% versus 3.2%) and death during the surgical episode (7.9% versus 3.6%)), compared to those without diabetes. Those without complications had rates comparable to the population without diabetes. The odds of death within a year of diagnosis were higher for those with complicated diabetes compared to those without diabetes [OR 1.58 (95%CI 1.51-1.66) p < 0.01], but no difference was observed between those with uncomplicated diabetes and those without diabetes [OR 1.05 (95%CI 0.99-1.11) p = 0.10].
Prediction of outcome following surgery in colorectal cancer patients with diabetes relies on the accurate assessment of complications. This study suggests that the poor post-operative outcomes in diabetes patients may be associated with diabetes complication rather than diabetes itself.
糖尿病被认为是癌症诊断后死亡的一个危险因素。我们假设，由于人群的异质性和对血管并发症的准确分类，风险会有所不同，这将提高对临床结果的预测能力。
利用 COloRECTal cancer data Repository（CORECT-R），我们在英格兰确定了 2005 年至 2016 年间接受结直肠癌切除术的原发性结直肠癌患者。在癌症诊断前的六年住院期间，使用 ICD10 编码（E10-E14）记录糖尿病，并发症状态使用改良后的糖尿病并发症严重程度指数（aDCSI）确定。比较各组之间的生存和术后结果。
在 232367 名患者中，有 28642 名（12.3%）被记录为患有糖尿病，其中 49.2%根据 aDCSI 存在并发症。与无糖尿病患者相比，有糖尿病并发症的患者术后不良结局发生率更高（90 天术后死亡率（6.6%对 3.2%）和手术期间死亡（7.9%对 3.6%））。无并发症的患者与无糖尿病患者的发生率相当。与无糖尿病患者相比，有复杂糖尿病的患者在诊断后一年内死亡的几率更高[比值比（OR）1.58（95%置信区间 1.51-1.66）p<0.01]，但无并发症的糖尿病患者与无糖尿病患者之间无差异[OR 1.05（95%置信区间 0.99-1.11）p=0.10]。
对糖尿病结直肠癌患者手术后结局的预测取决于对并发症的准确评估。本研究表明，糖尿病患者术后不良结局可能与糖尿病并发症有关，而与糖尿病本身无关。
