AIM:The aim of this study was to seek an association between the control of type 2 diabetes mellitus (T2DM), as determined by hemoglobin A1c (HbA1c) levels, and the outcome of colorectal cancer (CRC). METHODS:We performed a retrospective review of patients with T2DM who had CRC diagnosed between 1997 and 2001. We defined well-controlled T2DM as HbA1c < 7.5% and poorly controlled T2DM as HbA1c > or = 7.5%. A group of age- and gender-matched patients who had CRC without T2DM were used as controls. Forty clinical factors were reviewed, and those associated with poor clinical outcome in each group were examined by univariate analysis (UA) and by the maximum likelihood analysis of logistic regression to determine the independent predictors of cancer outcome. RESULTS:We identified 155 patients with T2DM and CRC, and 114 control patients who had CRC without T2DM. We found no significant differences in any clinical factor by UA between the patients with well-controlled T2DM and the patients who had CRC without T2DM. Compared to both of those patients groups, in contrast, the patients with poorly controlled T2DM had more right-sided CRCs (P = 0.04, OR = 2, 95% CI = 1-4.1), more advanced CRCs (P = 0.02, OR = 2.1, 95% CI = 1-4.4), a younger age of presentation (P = 0.05), greater use of exogenous insulin (P = 0.002), and a poorer 5-year survival (P = 0.001) by UA. Logistic regression showed that poorly controlled T2DM independently predicted the early onset of CRC, a more advanced stage at the time of presentation, poorer 5-year survival, and an increased incidence of right-sided CRCs. CONCLUSIONS:In patients with T2DM who have CRC, poor glycemic control is associated with a clinically aggressive course for the cancer.

译文

目的:本研究的目的是寻找通过血红蛋白A1c(HbA1c)水平确定的2型糖尿病(T2DM)控制与结直肠癌(CRC)的结局之间的关联。
方法:我们对1997年至2001年间被确诊为CRC的T2DM患者进行了回顾性研究。我们将控制良好的T2DM定义为HbA1c <7.5%,将控制不良的T2DM定义为HbA1c>或= 7.5%。一组年龄和性别匹配的无T2DM的CRC患者被用作对照。回顾了40种临床因素,并通过单因素分析(UA)和逻辑回归的最大似然分析检查了每组与临床结果差相关的因素,以确定癌症结果的独立预测因子。
结果:我们确定了155例T2DM和CRC的患者,以及114例没有T2DM的CRC的对照患者。我们发现,在控制良好的T2DM患者和患有CRC而无T2DM的患者之间,UA的任何临床因素均无显着差异。相比之下,与这两个患者组相比,控制不佳的T2DM患者的右侧CRC较多(P = 0.04,OR = 2,95%CI = 1-4.1),晚期CRC(P = 0.02,OR = 2.1,95%CI = 1-4.4),较年轻的患者(P = 0.05),更多使用外源性胰岛素(P = 0.002),UA的5年生存率较差(P = 0.001)。 Logistic回归显示,控制不佳的T2DM独立预测CRC的早期发作,出现时更晚期,5年生存期较差以及右侧CRC的发生率增加。
结论:在患有CRC的T2DM患者中,血糖控制不良与该癌症的临床侵袭性病程有关。

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