La Vecchia C, Negri E, Franceschi S, D'Avanzo B, Boyle P
Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
Br J Cancer. 1994 Nov;70(5):950-3. doi: 10.1038/bjc.1994.427.
The relationship between diabetes mellitus and cancer risk was investigated using data from an integrated series of case-control studies conducted in Northern Italy between 1983 and 1992. Cases were 9,991 patients with incident, histologically confirmed neoplasms below age 75, including 181 cancers of the oral cavity and pharynx, 316 of the oesophagus, 723 of the stomach, 828 of the colon, 498 of the rectum, 320 of the liver, 58 of the gall bladder, 362 of the pancreas, 242 of the larynx, 3,415 of the breast, 726 of the endometrium, 971 of the ovary, 125 of the prostate, 431 of the bladder, 187 of the kidney, 208 of the thyroid, 80 Hodgkin's lymphomas, 200 non-Hodgkin's lymphomas and 120 multiple myelomas. Controls were 7,834 subjects in hospital for acute, non-neoplastic, non-metabolic, non-hormone-related disorders. A history of diabetes was reported by 5.1% of male and 5.4% of female controls. Significantly elevated relative risks (RRs) among subjects with diabetes were observed for cancers of the liver [RR = 2.8, 95% confidence interval (CI) 2.0-3.9], pancreas (RR = 2.1, 95% CI 1.5-2.9) and endometrium (RR 3.4, 95% CI 2.7-4.3). After allowance for obesity and education as well as age and sex, the RRs were 3.0 for liver, 2.3 for pancreas, and 2.8 for endometrium. Diabetic subjects had no elevated risk for any of the other cancer sites considered. For liver and endometrial cancer the RRs remained elevated up to 10 years after diagnosis of diabetes (RR 2.6 and 2.0 respectively), while the RR for pancreatic cancer declined from 3.2 in the first 5 years after diagnosis of diabetes to 2.3 from 5 to 9 years and to 1.3 (95% CI 0.7-2.3) 10 or more years since diagnosis. This suggests that the relationship between diabetes mellitus and liver and endometrial cancer is probably real, while that with pancreatic cancer is compatible with diabetes being an early symptom of the disease, or at least of preneoplastic lesions.
利用1983年至1992年在意大利北部开展的一系列综合病例对照研究的数据，对糖尿病与癌症风险之间的关系进行了调查。病例为9991例年龄在75岁以下、经组织学确诊的新发肿瘤患者，包括181例口腔和咽癌、316例食管癌、723例胃癌、828例结肠癌、498例直肠癌、320例肝癌、58例胆囊癌、362例胰腺癌、242例喉癌、3415例乳腺癌、726例子宫内膜癌、971例卵巢癌、125例前列腺癌、431例膀胱癌、187例肾癌、208例甲状腺癌、80例霍奇金淋巴瘤、200例非霍奇金淋巴瘤和120例多发性骨髓瘤。对照为7834名因急性、非肿瘤性、非代谢性、非激素相关疾病住院的受试者。男性对照中有5.1%、女性对照中有5.4%报告有糖尿病病史。糖尿病患者中，肝癌（相对危险度[RR]=2.8，95%置信区间[CI]2.0 - 3.9）、胰腺癌（RR = 2.1，95% CI 1.5 - 2.9）和子宫内膜癌（RR 3.4，95% CI 2.7 - 4.3）的相对危险度显著升高。在考虑了肥胖、教育程度以及年龄和性别因素后，肝癌的RR为3.0，胰腺癌为2.3，子宫内膜癌为2.8。糖尿病患者在其他所考虑的癌症部位风险并未升高。对于肝癌和子宫内膜癌，糖尿病诊断后长达10年RR仍升高（分别为RR 2.6和2.0），而胰腺癌的RR从糖尿病诊断后的前5年的3.2降至5至9年的2.3，诊断后10年及以上降至1.3（95% CI 0.7 - 2.3）。这表明糖尿病与肝癌和子宫内膜癌之间的关系可能是真实的，而与胰腺癌的关系符合糖尿病是该疾病，或至少是癌前病变的早期症状。
