4.5 Article

Preexisting Type 2 Diabetes and Survival among Patients with Colorectal Cancer

Journal

CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION
Volume 30, Issue 4, Pages 757-764

Publisher

AMER ASSOC CANCER RESEARCH
DOI: 10.1158/1055-9965.EPI-20-1083

Keywords

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Funding

  1. NIH [UM1 CA186107, P01 CA87969, U01 CA167552, K07 CA188126, R01 CA137178, K24 DK098311, P50 CA127003, R35 CA197735, K07 CA148894, R01 CA205406]
  2. Pussycat Foundation Helen Gurley Brown Presidential Initiative
  3. American Cancer Society Research Scholar grant [RSG NEC-130476]
  4. Damon Runyon Cancer Research Foundation
  5. Entertainment Industry Foundation's National Colorectal Cancer Research Alliance (NCCRA)
  6. Project P Fund

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Among patients with colorectal cancer, preexisting diabetes was associated with increased risk of long-term mortality, particularly from other malignancies and cardiovascular disease. The impact of diabetes on survival varied by sex, with women showing a modest increase in overall mortality in the first 5 years after cancer diagnosis. Beyond 5 years, both men and women with diabetes at diagnosis had substantially increased overall mortality.
Background: Type 2 diabetes increases risk of developing colorectal cancer, but the association of preexisting diabetes with colorectal cancer survival remains unclear. Methods: We analyzed survival by diabetes status at cancer diagnosis among 4,038 patients with colorectal cancer from two prospective U.S. cohorts. Cox proportional hazards regression was used to calculate HRs and 95% confidence intervals (CI) for overall and cause-specific mortality, with adjustment for tumor characteristics and lifestyle factors. Results: In the first 5 years after colorectal cancer diagnosis, diabetes was associated with a modest increase in overall mortality in women (HR, 1.22; 95% CI, 1.00-1.49), but not in men (HR, 0.83; 95% CI, 0.62-1.12; P heterogeneity by sex = 0.04). Beyond 5 years, diabetes was associated with substantially increased overall mortality with no evidence of sex heterogeneity; in women and men combined, the HRs were 1.45 (95% CI, 1.09-1.93) during >5-10 years and 2.58 (95% CI, 1.91-3.50) during > 10 years. Compared with those without diabetes, patients with colorectal cancer and diabetes had increased mortality from other malignancies (HR, 1.78; 95% CI, 1.18-2.67) and cardiovascular disease (HR, 1.93; 95% CI, 1.29-2.91). Only women with diabetes for more than 10 years had increased mortality from colorectal cancer (HR, 1.33; 95% CI, 1.01-1.76). Conclusions: Among patients with colorectal cancer, preexisting diabetes was associated with increased risk of long-term mortality, particularly from other malignancies and cardiovascular disease. Impact: Our findings highlight the importance of cardioprotection and cancer prevention to colorectal cancer survivors with diabetes.

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