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Type 2 diabetes associated with higher all-cause mortality in ovarian cancer
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Women with ovarian cancer and type 2 diabetes have a 40% to 50% relative increase in the risk for long-term all-cause mortality and long-term cancer-specific morality vs. women with ovarian cancer who do not have diabetes, according to a recent meta-analysis.
Dongyu Zhang, MSc, MD, of the department of epidemiology at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, and colleagues analyzed 12 studies conducted between 1961 and 2012 investigating the overall survival, all-cause mortality or cancer-specific mortality of patients with ovarian cancer and diabetes, using RRs or HRs (17,451 total ovarian cancer cases). Seven studies were conducted in the United States, four in Europe and one in Asia; six studies were population based; six were clinic based.
In assessing the four studies reporting the median survival time stratified by diabetes, researchers observed a longer overall survival time for patients with ovarian cancer who did not have diabetes vs. those with diabetes.
The synthesized RR for all-cause mortality was 1.44 (95%, CI 1.16-1.79); the synthesized RR for cancer-specific mortality was 1.44 (95% CI, 1.08-1.93), although with substantial heterogeneity (P < .001). Researchers observed no publication bias across studies.
The researchers proposed several explanations for the associations. Insulin resistance and insulin deficiency may negatively influence the prognosis of patients with cancer, they wrote, as both may induce the expression of cytokines, such as interleukin-6, that could have a tumor-promoting effect.
“Moreover, [the] long-term use of insulin and [insulin resistance] can be associated with an increased risk of hyperinsulinemia, which can activate insulin-like growth factor signaling pathways and induce mitogenic effect and tumor promotion,” the researchers wrote.
In addition, patients with ovarian cancer and diabetes may receive different therapies compared with patients who do not have diabetes, due to a higher prevalence of comorbidities and an overall worse health condition, they wrote. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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