Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China.
Department of Oncology and Hematology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China.
Cancer Res Treat. 2021 Jul;53(3):714-723. doi: 10.4143/crt.2020.481. Epub 2020 Dec 2.
The prevalence of multi-morbidities with colorectal cancer (CRC) is known to be increasing. Particularly prognosis of CRC patients co-diagnosed with metabolic syndrome (MetSyn) was largely unknown. We aimed to examine the death risk of CRC patients according to the multiple MetSyn morbidities.
We identified CRC patients with MetSyn from the electronic medical records (EMR) systems in five independent hospitals during 2006-2011. Information on deaths was jointly retrieved from EMR, cause of death registry and chronic disease surveillance as well as study-specific questionnaire. Cox proportional hazards regression was used to calculate the overall and CRC-specific hazards ratios (HR) comparing MetSyn CRC cohort with reference CRC cohort.
A total of 682 CRC patients in MetSyn CRC cohort were identified from 24 months before CRC diagnosis to 1 month after. During a median follow-up of 92 months, we totally observed 584 deaths from CRC, 245 being in MetSyn cohort and 339 in reference cohort. Overall, MetSyn CRC cohort had an elevated risk of CRC-specific mortality (HR, 1.49; 95% confidence interval [CI], 1.07 to 1.90) and overall mortality (HR, 1.43; 95% CI, 1.09 to 1.84) compared to reference cohort after multiple adjustment. Stratified analyses showed higher mortality risk among women (HR, 1.87; 95% CI, 1.04 to 2.27) and specific components of MetSyn. Notably, the number of MetSyn components was observed to be significantly related to CRC prognosis.
Our findings supported that multi-morbidities of MetSyn associated with elevated death risk after CRC. MetSyn should be considered as an integrated medical condition more than its components in CRC prognostic management.
患有结直肠癌（CRC）的多种合并症的患病率增加是已知的。特别是同时诊断出代谢综合征（MetSyn）的 CRC 患者的预后情况还不太清楚。我们旨在根据多种 MetSyn 合并症来检查 CRC 患者的死亡风险。
我们从 2006 年至 2011 年期间在五家独立医院的电子病历（EMR）系统中确定了患有 MetSyn 的 CRC 患者。从 EMR、死因登记处和慢性病监测以及特定于研究的问卷中联合检索有关死亡的信息。使用 Cox 比例风险回归来计算总体和 CRC 特异性风险比（HR），以将 MetSyn CRC 队列与参考 CRC 队列进行比较。
从 CRC 诊断前 24 个月到诊断后 1 个月，在 MetSyn CRC 队列中确定了 682 例 CRC 患者。在中位数为 92 个月的随访期间，我们总共观察到 584 例 CRC 死亡，245 例发生在 MetSyn 队列中，339 例发生在参考队列中。总体而言，与参考队列相比，MetSyn CRC 队列在 CRC 特异性死亡率（HR，1.49；95%置信区间[CI]，1.07 至 1.90）和总体死亡率（HR，1.43；95%CI，1.09 至 1.84）方面具有更高的死亡风险。分层分析表明，女性（HR，1.87；95%CI，1.04 至 2.27）和 MetSyn 的特定成分的死亡率风险更高。值得注意的是，MetSyn 的成分数量与 CRC 的预后明显相关。
我们的研究结果支持 MetSyn 的多种合并症与 CRC 后死亡风险升高有关。在 CRC 预后管理中，应将 MetSyn 视为一种综合病症，而不仅仅是其成分。
