Impact of diabetes mellitus on the prognosis of patients with oral squamous cell carcinoma: a retrospective cohort study.
BACKGROUND
Diabetes mellitus (DM) is a prevalent chronic metabolic disease reported to affect the treatment outcomes of malignancies. This study explores the impact of diabetes on the prognosis of oral squamous cell carcinoma (OSCC).


METHODS
Clinicopathological characteristics and survival in terms of overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) of patients with OSCC who underwent surgical intervention at the Taipei Veterans General Hospital between 2002 and 2005 were stratified by diabetic status and compared.


RESULTS
Patients with DM tend to have a lower OS, RFS, and CSS compared with nondiabetics (adjusted hazard ratio [HR] = 2.22, 2.42, and 2.16, respectively) even in less aggressive tumor stages (stage I and II). In advanced tumors, diabetic patients who were not prescribed adjuvant therapy had a significantly higher recurrence rate than nondiabetic patients (HR = 2.66). However, there was no significant difference in treatment outcome in patients with locally advanced tumors amenable to receive adjuvant therapy, even with the delayed initiation of adjuvant therapy in the DM group (49.1 +/- 22.3 days vs. 40.0 +/- 16.6 days, P = .04). DM was also associated with a higher frequency of perineural invasion (adjusted odds ratio [OR] = 2.53).


CONCLUSIONS
DM status could be a prognostic factor for OSCC, particularly for its effect in the survival and perineural invasion. Although diabetes-associated comorbidities may impair decision making toward less aggressive therapeutic modality, adjuvant treatment may be essential for DM patients to improve their survival.
Oral and Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Cheng-Hsien
CH
Wu
Tzu-Ying
TY
Wu
Chia-Chen
CC
Li
Man-Tin
MT
Lui
Kuo-Wei
KW
Chang
Shou-Yen
SY
Kao
D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality* / Q000601:surgery; D015331:Cohort Studies; D048909:Diabetes Complications; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome