Diabetes Mellitus as a Prognostic Factor for Locally Advanced Rectal Cancer

Abstract

Background/Aim: Currently, the impact of diabetes mellitus (DM) on rectal cancer patients is complex and just partly elucidated. The purpose of this study was to investigate the impact of diabetes mellitus on rectal cancer patients focusing on tumor differentiation grade, neoadjuvant chemoradiotherapy (NACRT) response, disease-free (DFS) and overall (OS) survival. Patients and Methods: Our study's population consisted of a group of 53 patients diagnosed with locally advanced rectal cancer, who underwent NACRT, followed by radical oncological surgery. This patient population was further divided into two groups according to diabetes presence. Results: Downstaging rates, local control, DFS, and OS were lower in the DM subgroup compared to the non-DM locally advanced rectal cancer patients. Conclusion: The presence of DM at the time of diagnosis of locally advanced rectal cancer patients may be a negative predictive factor for response to neoadjuvant therapy, distant metastases, and local recurrences rates.Diabetes mellitus (DM) is one of the main chronic metabolic diseases, which have been linked to kidney, heart, and nerve damage. Currently, 422 million people worldwide have diabetes, and, despite global preventive measures, incidence and prevalence rates have been constantly increasing in the last decades (1). One of the most investigated organ-related consequences of DM is the one on kidney function (2-4), a life-threatening association if we consider the role of DM in end-stage renal disease (5).Previous retrospective studies have reported that, for other pelvic tumors (e.g. cervix uteri, bladder), amongst other irradiation response predictive factors, such as smoking status, treatment duration, radiation total dose, target volume proximity, and local anatomy, DM can also act as one of these clinically meaningful factors for the increased incidence of adverse events development (6-8). In the last decade, after an increase in colorectal cancer incidence worldwide, the connection between DM and this malignancy has been thoroughly investigated (9). There are several studies showing that patients with rectal cancer and DM have a poorer prognosis than non-DM patients (10). Although diabetic patients with rectal cancer have an inferior 2495 This article is freely accessible online.

Metformin Does not Affect Outcomes in Patients With Locally Advanced Rectal Cancer Treated With Neoadjuvant Therapy and Resection

“…However, the findings could be explained by higher age and lower rates of adjuvant therapy, and not due to DM itself, as observed in our multivariate analysis. The findings on univariate analysis is in line with findings by Georgescu et al, 33 however, they could not perform multivariate analysis due to small sample size. The current literature on the effect of DM on the prognosis of rectal cancer remains debatable.…”

“…The current literature on the effect of DM on the prognosis of rectal cancer remains debatable. 14,15,31,33 The conflicting results of the effect of metformin in population-based studies can be explained at least in part, due to the heterogeneity in study designs (observational/ trials with variable regimens/systematic reviews and meta-analyses) and comparison groups (diabetic metformin users/diabetic non-metformin users/non-diabetics). Further, observational studies studying drug effects tend to be susceptible to time-related biases such as immortal-time bias (misclassification or ignorance of variation in the timing of treatment initiation from cohort entry), time-window bias (cases and controls not matched on the duration of exposure opportunity time within a fixed observation period), and time-lagging bias (when a first-line therapy is compared to the second-or third-line of therapy given at a different disease stage) resulting in potential overestimation of a drug effect when there is none.…”

Variable cardiovascular risk factors is a risk factor for overall survival of patients with esophageal squamous cell carcinoma after surgery: a retrospective cohort study

“…L. Fernández-Arce et al revealed that diabetes was a predictor of all-cause mortality in Spanish women with breast cancer [6]. Dragos Eugen Georgescu et al found that rectal cancer patients with diabetes had a higher risk of death than those without diabetes [7]. Kaori Hisanaga et al showed that diabetes was an independent risk factor for OS in patients with lung cancer [8].…”

Blood Group Type Association with Head and Neck Cancer

“…Recent research in medical oncology focused on different types of cancer, depending on their frequency, identifying a series of diverse factors [ 7 ] which influenced the evolution of the disease as well as the treatment outcome. While these results led to new therapeutic approaches [ 8 ] which generated better treatment outcomes even in metastatic stages [ 9 , 10 ], cancer is still one of the leading causes of death in the EU and USA [ 11 , 12 ].…”