National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA.
EBioMedicine. 2022 Dec;86:104345. doi: 10.1016/j.ebiom.2022.104345. Epub 2022 Nov 11.
Limited data indicate that patients with colorectal cancer (CRC) are at higher risk of developing type 2 diabetes (T2D). We prospectively examined the risk of T2D between individuals with and without CRC in three large cohorts and conducted a meta-analysis.
We assessed the diagnosis of CRC and T2D among 111,485 women from the Nurses' Health Study, 112,958 women from the Nurses' Health Study II, and 46,581 men from the Health Professionals Follow-up Study. We used multivariable Cox regression with time-varying covariates to calculate the hazard ratio (HR) of T2D in relation to CRC diagnosis. We further performed a systematic review and meta-analysis of cohort studies.
Up to 36 years of follow-up (6.9 million person-years), we documented 3402 incident CRC cases and 26,469 T2D cases. Compared to non-CRC individuals, those with CRC were more likely to develop T2D (multivariable-adjusted HR 1.20, 95% CI 1.05-1.38). The association was most evident for individuals with fewer risk factors for T2D. In the meta-analysis of seven cohort studies (1,061,744 participants), CRC was associated with higher T2D risk (meta-analysis HR 1.21, 95% CI 1.11-1.31, I = 57.9%). By CRC duration, a statistically significant association was observed in the first 10 years but not after 10 years of CRC diagnosis (≤5 years, meta-analysis HR 1.32, 95% CI 1.27-1.36; 5.1-10 years, 1.14 [1.04-1.25]; >10 years, 1.14 [0.91-1.37]).
CRC was associated with increased T2D risk, especially in the first ten years after CRC diagnosis. Our findings highlight the importance of T2D prevention for CRC survivorship care.
NHS cohort infrastructure grant (UM1 CA186107), NHS program project grant that funds cancer research (P01 CA87969), NHS II cohort infrastructure grant (U01 CA176726), HPFS cohort infrastructure grant (U01 CA167552) and the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2021-I2M-1-010).
有限的数据表明，结直肠癌（CRC）患者发生 2 型糖尿病（T2D）的风险更高。我们前瞻性地在三个大型队列中检查了 CRC 患者与非 CRC 患者之间 T2D 的发病风险，并进行了荟萃分析。
我们评估了来自护士健康研究的 111485 名女性、护士健康研究 II 的 112958 名女性和健康专业人员随访研究的 46581 名男性中 CRC 和 T2D 的诊断。我们使用带有时间变化协变量的多变量 Cox 回归来计算与 CRC 诊断相关的 T2D 的风险比（HR）。我们进一步对队列研究进行了系统评价和荟萃分析。
在长达 36 年的随访（690 万人年）中，我们记录了 3402 例 CRC 病例和 26469 例 T2D 病例。与非 CRC 个体相比，CRC 患者发生 T2D 的可能性更高（多变量调整后的 HR 1.20，95%CI 1.05-1.38）。对于 T2D 风险因素较少的个体，这种关联最为明显。在对七项队列研究（1061744 名参与者）的荟萃分析中，CRC 与更高的 T2D 风险相关（荟萃分析 HR 1.21，95%CI 1.11-1.31，I=57.9%）。根据 CRC 持续时间，在诊断后 10 年内观察到统计学显著的关联，但在 10 年以上时则没有（≤5 年，荟萃分析 HR 1.32，95%CI 1.27-1.36；5.1-10 年，1.14[1.04-1.25]；>10 年，1.14[0.91-1.37]）。
CRC 与 T2D 风险增加相关，尤其是在 CRC 诊断后的前 10 年内。我们的研究结果强调了 T2D 预防对 CRC 生存者护理的重要性。
NHS 队列基础设施赠款（UM1 CA186107）、资助癌症研究的 NHS 项目赠款（P01 CA87969）、NHS II 队列基础设施赠款（U01 CA176726）、HPFS 队列基础设施赠款（U01 CA167552）和中国医学科学院创新基金医学科学（2021-I2M-1-010）。
