Diabetes severity affects survival after colorectal cancer surgery

ByJennifer R. Southall

Fact checked byMindy Valcarcel, MS

Key takeaways:

Patients with diabetes with complications experienced significantly worse outcomes.
Those with colorectal cancer and diabetes additionally experienced a higher risk for disease recurrence.

Researchers observed an inverse association between diabetes severity and survival outcomes among patients who underwent curative resection for colorectal cancer, according to study results.

The findings — published in Cancer — specifically showed those with earlier-stage colorectal cancer and women experienced the worst survival outcomes, researchers concluded.

Diabetes glucose test 2 2019 — Patients with complicated diabetes experienced significantly worse OS after colorectal cancer surgery. *Source: Adobe Stock.*

Rationale and methodology

Although it is known that diabetes is a poor prognostic factor for colorectal cancer, the prognostic impact of diabetes severity among those with colorectal cancer is not fully known, according to Kuo‐Liong Chien, MD, PhD, researcher at National Taiwan University, and colleagues.

For this reason, Chien and colleagues conducted a population-based retrospective cohort study that included 59,202 individuals included in the Taiwan Cancer Registry Database with stage I to stage III colorectal cancer who underwent surgery with curative intent.

Researchers sought to examine the prognostic differences after curative resection for colorectal cancer according to diabetes status, which included no diabetes, diabetes without complications and diabetes with complications.

They used Cox regression analysis to determine the association between diabetes severity and colorectal cancer survival, including OS, DFS, time to recurrence and cancer-specific survival.

Findings

Overall, 9,448 patients experienced cancer recurrence and 21,031 died of any cause during the study period.

Results showed that compared with those with no diabetes, patients with diabetes without complications experienced insignificantly worse OS (HR = 1.05; 95% CI, 1.01-1.09), DFS (HR = 1.08; 95% CI, 1.04-1.12) and cancer-specific survival (HR = 0.98; 95% CI, 0.93-1.03), while those with complicated diabetes experienced significantly worse OS (HR = 1.85; 95% CI, 1.78-1.92), DFS (HR = 1.75; 95% CI, 1.69-1.82) and cancer-specific survival (HR = 1.41; 95% CI, 1.33-1.49).

Of note, those with colorectal cancer and diabetes additionally experienced a higher risk for recurrence compared with those without diabetes.

Further, researchers found both sex and TNM stage as significant effect modifiers among the patient population.

“While a higher diabetes prevalence was noted in patients with colorectal cancer, the study suggests that coordinated medical care involving multiple specialists can help prevent diabetes complications, potentially improving long-term colorectal cancer oncological outcomes, particularly in women and patients with early-stage cancer,” Chien said in a press release.

Researchers acknowledged limitations of the study, including that the cohort only involved patients with colorectal cancer in Taiwan, therefore limiting the study’s generalizability.

Future research

“These findings indicate that preventing diabetes complications may help improve survival in patients with colorectal cancer, especially female patients and those with early-stage disease. Thus, a multidisciplinary approach is recommended for patients with colorectal cancer,” the researchers wrote.