Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Cancer Epidemiol Biomarkers Prev. 2021 Apr;30(4):757-764. doi: 10.1158/1055-9965.EPI-20-1083. Epub 2021 Feb 2.
Type 2 diabetes increases risk of developing colorectal cancer, but the association of preexisting diabetes with colorectal cancer survival remains unclear.
We analyzed survival by diabetes status at cancer diagnosis among 4,038 patients with colorectal cancer from two prospective U.S. cohorts. Cox proportional hazards regression was used to calculate HRs and 95% confidence intervals (CI) for overall and cause-specific mortality, with adjustment for tumor characteristics and lifestyle factors.
In the first 5 years after colorectal cancer diagnosis, diabetes was associated with a modest increase in overall mortality in women (HR, 1.22; 95% CI, 1.00-1.49), but not in men (HR, 0.83; 95% CI, 0.62-1.12; heterogeneity by sex = 0.04). Beyond 5 years, diabetes was associated with substantially increased overall mortality with no evidence of sex heterogeneity; in women and men combined, the HRs were 1.45 (95% CI, 1.09-1.93) during >5-10 years and 2.58 (95% CI, 1.91-3.50) during >10 years. Compared with those without diabetes, patients with colorectal cancer and diabetes had increased mortality from other malignancies (HR, 1.78; 95% CI, 1.18-2.67) and cardiovascular disease (HR, 1.93; 95% CI, 1.29-2.91). Only women with diabetes for more than 10 years had increased mortality from colorectal cancer (HR, 1.33; 95% CI, 1.01-1.76).
Among patients with colorectal cancer, preexisting diabetes was associated with increased risk of long-term mortality, particularly from other malignancies and cardiovascular disease.
Our findings highlight the importance of cardioprotection and cancer prevention to colorectal cancer survivors with diabetes.
2 型糖尿病会增加罹患结直肠癌的风险，但患有糖尿病与结直肠癌患者生存状况之间的关联尚不清楚。
我们分析了来自两个美国前瞻性队列的 4038 例结直肠癌患者中，诊断时患有糖尿病的患者的生存情况。使用 Cox 比例风险回归计算了全因死亡率和特定原因死亡率的 HR 和 95%CI，调整了肿瘤特征和生活方式因素。
在结直肠癌诊断后的前 5 年内，女性糖尿病患者的总体死亡率略有升高（HR，1.22；95%CI，1.00-1.49），但男性没有（HR，0.83；95%CI，0.62-1.12；性别异质性=0.04）。5 年以后，糖尿病与总体死亡率显著升高相关，且没有性别异质性的证据；在女性和男性合并后，5-10 年的 HR 为 1.45（95%CI，1.09-1.93），10 年以上的 HR 为 2.58（95%CI，1.91-3.50）。与无糖尿病的患者相比，患有结直肠癌和糖尿病的患者死于其他恶性肿瘤（HR，1.78；95%CI，1.18-2.67）和心血管疾病（HR，1.93；95%CI，1.29-2.91）的风险更高。只有患有糖尿病超过 10 年的女性结直肠癌患者的死亡率更高（HR，1.33；95%CI，1.01-1.76）。
在患有结直肠癌的患者中，患有糖尿病与长期死亡率增加相关，尤其是死于其他恶性肿瘤和心血管疾病的风险增加。
我们的研究结果强调了对患有糖尿病的结直肠癌幸存者进行心脏保护和癌症预防的重要性。
