Guan Ruo-Yu, Wu Jia-Wei, Yuan Zi-Yun, Liu Zhi-Yuan, Liu Zi-Zhu, Xiao Zhi-Cong, Li Jing-Hui, Huang Cheng-Zhi, Wang Jun-Jiang, Yao Xue-Qing
Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, Guangdong Province, China.
Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, Guangdong Province, China.
World J Gastroenterol. 2025 Jan 21;31(3):98688. doi: 10.3748/wjg.v31.i3.98688.
Type II diabetes mellitus (T2DM) has been associated with increased risk of colon cancer (CC) and worse prognosis in patients with metastases. The effects of T2DM on postoperative chemoresistance rate (CRR) and long-term disease-free survival (DFS) and overall survival (OS) in patients with stage III CC who receive curative resection remain controversial.
To investigate whether T2DM or glycemic control is associated with worse postoperative survival outcomes in stage III CC.
This retrospective cohort study included 278 patients aged 40-75 years who underwent surgery for stage III CC from 2018 to 2021. Based on preoperative T2DM history, the patients were categorized into non-DM ( = 160) and DM groups ( = 118). The latter was further divided into well-controlled ( = 73) and poorly controlled ( = 45) groups depending on the status of glycemic control. DFS, OS, and CRR were compared between the groups and Cox regression analysis was used to identify risk factors.
Patients in the DM and non-DM groups demonstrated similar DFS, OS, and CRR (DFS: 72.03% 78.75%, = 0.178; OS: 81.36% 83.12%, = 0.638; CRR: 14.41% 7.5%, = 0.063). Poorly controlled DM was associated with a significantly worse prognosis and higher CRR than well-controlled DM (DFS: 62.22% 78.07%, = 0.021; OS: 71.11% 87.67%, = 0.011; CRR: 24.40% 8.22%, = 0.015). High preoperative fasting plasma glucose [DFS: Hazard ratio (HR) = 2.684, < 0.001; OS: HR = 2.105, = 0.019; CRR: HR = 2.214, = 0.005] and glycosylated hemoglobin levels (DFS: HR = 2.344, = 0.006; OS: HR = 2.119, = 0.021; CRR: HR = 2.449, = 0.009) indicated significantly poor prognosis and high CRR, while T2DM history did not (DFS: HR = 1.178, = 0.327; OS: HR = 0.933, = 0.739; CRR: HR = 0.997, = 0.581).
Increased preoperative fasting plasma glucose and glycosylated hemoglobin levels, but not T2DM history, were identified as risk factors associated with poor postoperative outcomes and high CRR in patients with stage III CC.
2型糖尿病（T2DM）与结肠癌（CC）风险增加及转移患者预后较差相关。T2DM对接受根治性切除的III期CC患者术后化疗耐药率（CRR）、长期无病生存期（DFS）和总生存期（OS）的影响仍存在争议。
探讨T2DM或血糖控制是否与III期CC患者术后生存结局较差相关。
这项回顾性队列研究纳入了2018年至2021年接受III期CC手术的278例40 - 75岁患者。根据术前T2DM病史，将患者分为非糖尿病组（n = 160）和糖尿病组（n = 118）。后者根据血糖控制情况进一步分为血糖控制良好组（n = 73）和控制不佳组（n = 45）。比较各组之间的DFS、OS和CRR，并采用Cox回归分析确定危险因素。
糖尿病组和非糖尿病组患者的DFS、OS和CRR相似（DFS：72.03% 对78.75%，P = 0.178；OS：81.36% 对83.12%，P = 0.638；CRR：14.41% 对7.5%，P = 0.063）。与血糖控制良好的糖尿病患者相比，血糖控制不佳的糖尿病患者预后明显更差，CRR更高（DFS：62.22% 对78.07%，P = 0.021；OS：71.11% 对87.67%，P = 0.011；CRR：24.40% 对8.22%，P = 0.015）。术前空腹血糖升高[DFS：风险比（HR）= 2.684，P < 0.001；OS：HR = 2.105，P = 0.019；CRR：HR = 2.214，P = 0.005]和糖化血红蛋白水平（DFS：HR = 2.344，P = 0.006；OS：HR = 2.119，P = 0.021；CRR：HR = 进行了一项回顾性队列研究，纳入了2018年至2021年接受III期CC手术的278例40 - 75岁患者。根据术前T2DM病史，将患者分为非糖尿病组（n = 160）和糖尿病组（n = 118）。后者根据血糖控制情况进一步分为血糖控制良好组（n = 73）和控制不佳组（n = 45）。比较各组之间的DFS、OS和CRR，并采用Cox回归分析确定危险因素。
糖尿病组和非糖尿病组患者的DFS、OS和CRR相似（DFS：72.03% 对78.75%，P = 0.178；OS：81.36% 对83.12%，P = 0.638；CRR：14.41% 对7.5%，P = 0.063）。与血糖控制良好的糖尿病患者相比，血糖控制不佳的糖尿病患者预后明显更差，CRR更高（DFS：62.22% 对78.07%，P = 0.021；OS：71.11% 对87.67%，P = 0.011；CRR：24.40% 对8.22%，P = 0.015）。术前空腹血糖升高[DFS：风险比（HR）= 2.684，P < 0.001；OS：HR = 2.105，P = 0.019；CRR：HR = 2.214，P = 0.005]和糖化血红蛋白水平（DFS：HR = 2.344，P = 0.006；OS：HR = 2.119，P = 0.021；CRR：HR = 2.449，P = 0.009）表明预后明显较差且CRR较高，而T2DM病史则不然（DFS：HR = 1.178，P = 0.327；OS：HR = 0.933，P = 0.739；CRR：HR = 0.997，P = 0.581）。
术前空腹血糖和糖化血红蛋白水平升高，但不是T2DM病史，被确定为与III期CC患者术后不良结局和高CRR相关的危险因素。 2.44 9，P = 0.009）表明预后明显较差且CRR较高，而T2DM病史则不然（DFS：HR = 1.178，P = 0.327；OS：HR = 0.933，P = 0.739；CRR：HR = 0.997，P = 0.581）。
术前空腹血糖和糖化血红蛋白水平升高，但不是T2DM病史，被确定为与III期CC患者术后不良结局和高CRR相关的危险因素。
