Impact of Diabetes Status on Long Term Oncological Outcome of Stage II Colorectal Cancer

糖尿病對第二期大腸直腸癌長期預後之影響

黃緒桓(Shu-Huan Huang) ； 蔡文司(Wen-Sy Tsai) ； j ； 王正儀 ； 張簡俊榮(Chun-Rong Changchien) ； 唐瑞平(Reiping Tang) ； 游耀東(Yau-Tong You) ； 江支銘(Jy-Ming Chiang) ； 葉建裕(Chien-Yuh Yeh) ； 謝寶秀(Pao-Shiu Hsieh) ； 游正府(Jeng-Fu You) ； 洪欣園(Hsin-Yuan Hung) ； 蔣昇甫(Sum-Fu Chiang) ； 賴正洲(Cheng-Chou Lai) ； 林耕平(Geng-Pin Lin) ； 陳進勛(Jinn-Shiun Chen)

《中華民國大腸直腸外科醫學會雜誌》 28卷2期 (2017/06) Pp. 101-110

https://doi.org/10.6312/SCRSTW.2017.28(2).10531

摘要

Purpose. Colorectal cancer and diabetes shared similar dietary and lifestyle risk factors. Many studies showed higher prevalence and poor overall survival of colorectal cancer among diabetes patients. However, the long term oncological outcome of colorectal cancer among diabetes patients was limited and non-conclusive. Methods. We presented a consecutive case series from our database of colorectal cancer from 1999 to 2002. Stage II colorectal cancer patients with curative resection were included and radiation therapy were excluded. Clinicopathological factors, long-term overall survival and oncological outcome were analyzed and compared between diabetes and non-diabetes patients. Result. Comparing the diabetes to non-diabetes group, DM patients had elder ages, higher BMI, higher rates of moderate to severe chronic renal failure (19 vs. 7.5%, p ＜ 0.001), CEA elevation over 5 ng/ml (55.2% vs. 33.6%, p ＜ 0.001), myocardial infarction (16.1% vs. 5.7%, p = 0.043) and congested heart failure (4.8% vs. 1.2%, p = 0.008) were significantly higher in diabetes group. Although overall survival showed no difference between DM and non-DM patients, the 5-year disease specific survival and 3-year disease free survival rates of diabetes group were 91% and 88%, significantly higher than 81% and 78% of non-diabetes group (p = 0.025 and 0.015, respectively). Diabetes showed improved disease free survival (hazard ratio = 0.192, p = 0.023) in multivariate Cox-regression modelafter adjusted with age, metformin using and other clinicopathological factors. On the other hand, diabetes only showed borderline improvement in disease specific survival after adjusted by metformin and other clinicopathological factors (HR = 0.258, p = 0.064). Conclusions. Diabetes presented to be a protective factor in oncological outcome against accompanied higher serum CEA level in stage II colorectal cancer with curative resection only.

關鍵字

Diabetes mellitus ； Colon ； Rectum ； Survival

並列摘要

目的 糖尿病與大腸直腸癌有相似的飲食及生活因子。目前許多研究均顯示糖尿病病患有較高的大腸直腸癌發生率及較差的總存活率，但是長期存活率及癌症相關存活率的研究卻相對有限且無一致的結論。方法 挑選本院1999 年至2002 年第二期大腸直腸癌接受根除性切除但排除接受放射治療之病患。比較糖尿病及非糖尿病病患之臨床病理表現、長期總存活率及癌症相關存活率，另外則比較不同糖尿病治療方式之癌症相關存活率之異同。結果 在大腸直腸癌病患中，罹患糖尿病的病患有較高的年齡、BMI、慢性腎衰竭 (19%vs. 7.5%, p ＜ 0.001)、心肌梗塞 (16.7% vs. 5.7%, p = 0.043)、心衰竭病史 (4.8% vs. 1.2%, p= 0.008) 及癌胚抗原數值 (CEA ＞ 5 ng/ml, 55.2 vs. 33.6%, p ＜ 0.001)。兩組間總體存活率並無顯著差異，但糖尿病病患比非糖尿病病患有顯著較高的5 年癌症相關存活率 (91%vs. 81%, p = 0.025) 及3 年疾病無復發率 (88% vs. 78%, p = 0.015)。在多變數分析中排除metformin 使用及其他因子後糖尿病仍有顯著較低之疾病復發率風險 (HR = 0.192, p =0.023)，然而多變數分析中糖尿病之癌症死亡率風險卻達邊緣性統計顯著 (HR = 0.258, p= 0.064)。結論 糖尿病在第二期大腸直腸癌病患中雖有較高的癌胚抗原值，但排除metformin 使用後糖尿病對於第二期大腸直腸癌之癌症預後為明顯保護因子。

並列關鍵字

糖尿病 ； 大腸直腸癌 ； 癌症相關存活率

參考文獻

Bae, S., et al., Impact of Diabetes Status and Medication on Presentation, Treatment, and Outcome of Stage II Colon Cancer Patients. J Cancer Epidemiol, 2015. 2015: p. 189132."

Ferlay, J., et al., Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 2010. 127(12): p. 2893-917."

Jemal, A., et al., Global cancer statistics. CA Cancer J Clin, 2011. 61(2): p. 69-90."

Guariguata, L., et al., Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes research and clinical practice, 2014. 103(2): p. 137-149."

Deng, L., et al., Diabetes mellitus and the incidence of colorectal cancer: an updated systematic review and meta-analysis. Dig Dis Sci, 2012. 57(6): p. 1576-85."