The Prognostic Impact of Type 2 Diabetes Mellitus on Early Cervical Cancer in Asia

Abstract

Background. Many studies have shown that type 2 diabetes mellitus (DM) increases the risk for several types of cancer but not cervical cancer (CC). Although DM and insulin‐like growth factor 1 have preclinical and clinical implications for CC, less is known about the prognostic impact of DM on patients with early stage CC. Patients and Methods. We used the nationwide Taiwan Cancer Registry database to collect the characteristics of stage I–IIA cervical cancer patients diagnosed between 2004 and 2008. DM and other comorbidities were retrieved from the National Health Insurance database. Cervical cancer‐specific survival (CSS) and overall survival (OS) times of patients according to DM status were estimated using the Kaplan‐Meier method. We used a Cox proportional hazards model to calculate adjusted hazard ratios (HRs) for the effects of DM and other risk factors on mortality. Results. A total of 2,946 patients had primary stage I–IIA CC and received curative treatments, and 284 (9.6%) had DM. The 5‐year CSS and OS rates for patients with DM were significantly lower than those without DM (CSS: 85.4% vs. 91.5%; OS: 73.9% vs. 87.9%). After adjusting for clinicopathologic variables and comorbidities, DM remained an independent unfavorable prognostic factor for CSS (adjusted HR: 1.46) and OS (adjusted HR: 1.55). Conclusion. In Asian patients with early cervical cancer, DM is an independent unfavorable prognostic factor influencing both OS and CSS, even after curative treatments. Implications for Practice: Type 2 diabetes mellitus (DM) increases the incidence of several types of cancer but not cervical cancer (CC); however, less is known about the impact of DM on patients who already have CC. This study suggests that DM may increase the risk of cancer recurrence and death for early stage CC patients, even after curative treatments. Incorporating DM control should be considered part of the continuum of care for early stage CC patients, and close surveillance during routine follow‐up in this population is recommended.

Impact of diabetes mellitus on oncological outcomes after radical hysterectomy for early stage cervical cancer

“…Furthermore, we found that early stage cervical cancer patients with type 2 DM had a decreased OS after controlling for comorbid conditions such as obesity and other clinicopathological factors. These results concur with an earlier study [ 15 19 ]. Similarly, Shah et al [ 8 ] evaluated the impact of DM on progression-free survival (PFS) and OS in 367 women with epithelial ovarian cancer.…”

“…We also found that there was no significant difference between patients with and without type 2 DM in FIGO stage, tumor size, histology, DSI, PI, node status, surgical margin or adjuvant treatment. However, our study did find that patients with type 2 DM were more likely to be older and overweight, which is comparable to previous studies [ 7 9 19 ]. These findings may be explained by the fact that the majority of patients with type 2 DM are obese.…”

“…They also found that cervical cancer patients with DM faced a worse outcome [ 15 ]. Since that study, there has been little published data on the relationship between high plasma glucose or type 2 DM and the clinical outcomes of cervical cancer [ 17 18 19 ]. Lee et al [ 17 ] investigated the association between pretreatment random plasma glucose levels and cancer prognosis in 134 non-DM patients with locally advanced cervical cancer, and found that high glucose levels (≥102 mg/dL) were associated with a greater risk of recurrence and mortality in these patients.…”

“…To the best of our knowledge, only one study has yet addressed the prognostic impact of type 2 DM on early stage cervical cancer [ 19 ]. Recently, a nationwide population-based study from Taiwan by Kuo et al [ 19 ] demonstrated that early stage cervical cancer patients with type 2 DM had less favorable overall survival (OS) and cancer-specific survival after curative treatments. However, this study was based on the Taiwan Cancer Registry and National Health Insurance databases and included patients who were heterogeneous in terms of treatment modalities.…”

Linking type 2 diabetes and gynecological cancer: an introductory overview

“…Regarding the impact of T2D on patients who already have CC, it has been suggested that T2D may increase the risk of cancer recurrence and death for early stage CC patients, even after curative treatments. Thus, incorporating T2D screening should be considered as part of the continuum of care for early stage CC patients, and close surveillance during routine follow-up in this population should be recommended [94].…”