糖尿病對於第二、三期大腸直腸癌病人之預後影響

Impact of Diabetes Mellitus on Outcomes in Patients With Stage II and III Colon Cancer

目的：本研究目的為分析糖尿病對於第二、三期大腸癌病人之預後影響，並瞭解其影響存活率之相關因素。方法：採回溯病歷資料方式收集2008年1月至2014年12月接受手術切除及輔助性化學治療之大腸癌病人的資料，共232位，其中70位病人被診斷為糖尿病。利用Kaplan-Meier分析糖尿病對於第二、三期大腸癌病人存活率，進而比較糖尿病對於第二、三期大腸癌病人存活率之影響因子，以Cox 向前逐步迴歸分析研究變項：糖尿病與非糖尿病大腸癌病人死亡率、復發率等死亡風險之預測因子，進而分析其無病存活率與整體存活率。結果：第二、三期大腸癌合併有糖尿病之病人相較於無糖尿病之病人有較差的5年存活率 (72.2% v s 80.4%; P=.008) 及無病存活率 (58.4% vs 85.1%; P＜.001)，合併有糖尿病之病人相較於無糖尿病之病人增加43%的死亡風險與23%的復發機率。結論：研究結果發現，第二、三期大腸癌合併有糖尿病之病人有較高的死亡率與復發率。研究結果可提供大腸癌合併有糖尿病之病人臨床治療之參考。

Purpose: To determine the influence of diabetes mellitus on long-term outcomes among patients with curatively resected colon cancer. Methods: This was a survival analysis study with retrospective design. We reviewed the records of 232 patients with adenocarcinoma of the colon cancer who had surgical intervention with curatively resected colon cancer patients between 2008 and 2014 at a teaching hospital in southern Taiwan. All the patients received surgical operation with adjuvant chemotherapy (AC), 70 patients were identified as having diabetes mellitus. Adverse events, odds ratio, disease free survival (DFS) and overall survival (OS) were studied between patients with diabetes and those without diabetes. Results: At 5 years, patients with diabetes mellitus, compared with patients without diabetes, experienced a significantly worse OS (72.2% diabetics vs 80.4% nondiabetics; P=.008), and DFS (58.4% vs 85.1%; P＜.001). Compared with patients without a history of diabetes, those with diabetes had a 43% increased risk of death from any cause (P=.01) and 23% increased risk for recurrence (P＜.0001) after adjustment for other predictors of colon cancer outcome. Conclusion: Our results indicate that patients with diabetes mellitus and high-risk stage II and stage III colon cancer experienced a significantly higher rate of overall mortality and cancer recurrence, even after adjustment for other predictors of colon cancer outcome. These results should determine whether improvements in prevention and treatment of diabetes mellitus will improve outcomes for colon cancer patients.