Disease-specific mortality among stage I–III colorectal cancer patients with diabetes: a large population-based analysis
Open Access
- 24 April 2012
- journal article
- research article
- Published by Springer Science and Business Media LLC in Diabetologia
- Vol. 55 (8), 2163-2172
- https://doi.org/10.1007/s00125-012-2555-8
Abstract
The aim of our study was to investigate overall and disease-specific mortality of colorectal cancer patients with diabetes. In this population-based study, we included all colorectal cancer patients, newly diagnosed with stage I–III cancer, between 1997 and 2007 in the registration area of the Eindhoven Cancer Registry. Stage of cancer, cancer treatment and comorbidities were actively collected by reviewing hospital medical records. Data on patients with and without diabetes were linked to Statistics Netherlands to assess vitality, date of death and underlying cause of death. Follow-up of all patients was completed until 1 January 2009. We included 6,974 patients with colon cancer and 3,888 patients with rectal cancer, of whom 820 (12%) and 404 (10%), respectively, had diabetes at the time of cancer diagnosis. During follow-up, death occurred in 611 (50%) of 1,224 cancer patients with diabetes and 3,817 (40%) of 9,638 cancer patients without diabetes. Multivariate Cox regression analyses, adjusted for age, sex, socioeconomic status, stage, lymph nodes examined, adjuvant therapy and year of diagnosis, showed that overall mortality was significantly higher for colon (HR 1.12, 95% CI 1.01, 1.25) and rectal (HR 1.21, 95% CI 1.03, 1.41) cancer patients with diabetes than for those without. Disease-specific mortality was only significantly increased for rectal cancer patients (HR 1.30, 95% CI 1.06, 1.60). Diabetes at the time of rectal cancer diagnosis was independently associated with an increased risk of colorectal cancer mortality compared with no diabetes, suggesting a specific interaction between diabetes and rectal cancer. Future in-depth studies including detailed diabetes- and cancer-related variables should elucidate pathways.Keywords
This publication has 48 references indexed in Scilit:
- Diabetes and CancerDiabetes Care, 2010
- Metformin Associated With Lower Cancer Mortality in Type 2 DiabetesDiabetes Care, 2009
- Colorectal Cancer Outcomes, Recurrence, and Complications in Persons With and Without Diabetes Mellitus: A Systematic Review and Meta-AnalysisDigestive Diseases and Sciences, 2009
- Prognostic Models With Competing RisksEpidemiology, 2009
- Risk of malignancies in patients with diabetes treated with human insulin or insulin analogues: a cohort studyDiabetologia, 2009
- New Users of Metformin Are at Low Risk of Incident CancerDiabetes Care, 2009
- Insulin, the Insulin-Like Growth Factor Axis, and Mortality in Patients With Nonmetastatic Colorectal CancerJournal of Clinical Oncology, 2009
- Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes MellitusJama-Journal Of The American Medical Association, 2008
- Overweight, obesity and cancer: epidemiological evidence and proposed mechanismsNature Reviews Cancer, 2004
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987