Impact of Diabetes on Oncologic Outcome of Colorectal Cancer Patients: Colon vs. Rectal Cancer

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Authors: Justin Y. Jeon ; Duck Hyoun Jeong ; Min Geun Park ; Ji-Won Lee ; Sang Hui Chu ; Ji-Hye Park ; Mi Kyung Lee ; Kaori Sato ; Jennifer A. Ligibel ; Jeffrey A. Meyerhardt ; Nam Kyu Kim

MeSH: Aged ; Cohort Studies ; Colonic Neoplasms/drug therapy* ; Colonic Neoplasms/mortality* ; Colorectal Neoplasms/drug therapy* ; Colorectal Neoplasms/mortality* ; Confidence Intervals ; Diabetes Mellitus/mortality* ; Diabetes Mellitus/physiopathology ; Disease-Free Survival ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Rectal Neoplasms/drug therapy* ; Rectal Neoplasms/mortality* ; Republic of Korea/epidemiology ; Treatment Outcome

Keywords: Aged ; Cohort Studies ; Colonic Neoplasms/drug therapy* ; Colonic Neoplasms/mortality* ; Colorectal Neoplasms/drug therapy* ; Colorectal Neoplasms/mortality* ; Confidence Intervals ; Diabetes Mellitus/mortality* ; Diabetes Mellitus/physiopathology ; Disease-Free Survival ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Rectal Neoplasms/drug therapy* ; Rectal Neoplasms/mortality* ; Republic of Korea/epidemiology ; Treatment Outcome

Abstract: BACKGROUND:
To evaluate the impact of diabetes on outcomes in colorectal cancer patients and to examine whether this association varies by the location of tumor (colon vs. rectum).
PATIENTS AND METHODS:
This study includes 4,131 stage I-III colorectal cancer patients, treated between 1995 and 2007 (12.5% diabetic, 53% colon, 47% rectal) in South Korea. Cox proportional hazards modeling was used to determine the prognostic influence of DM on survival endpoints.
RESULTS:
Colorectal cancer patients with DM had significantly worse disease-free survival (DFS) [hazard ratio (HR) 1.17, 95% confidence interval (CI): 1.00-1.37] compared with patients without DM. When considering colon and rectal cancer independently, DM was significantly associated with worse overall survival (OS) (HR: 1.46, 95% CI: 1.11-1.92), DFS (HR: 1.45, 95% CI: 1.15-1.84) and recurrence-free survival (RFS) (HR: 1.32, 95% CI: 0.98-1.76) in colon cancer patients. No association for OS, DFS or RFS was observed in rectal cancer patients. There was significant interaction of location of tumor (colon vs. rectal cancer) with DM on OS (P = 0.009) and DFS (P = 0.007).
CONCLUSIONS:
This study suggests that DM negatively impacts survival outcomes of patients with colon cancer but not rectal cancer.