title: Impact of diabetes on overall and cancer-specific mortality in colorectal cancer patients.
abstract: OBJECTIVE
  Diabetes is associated with increased risk of developing colorectal cancer (CRC), but its effect on overall and cancer-specific mortality in CRC patients has been little investigated. The aim of this study was to assess the influence of diabetes on overall and cancer-specific mortality in Italian CRC patients.
  
  
  METHODS
  Cases of adult (≥15 years) CRC, diagnosed in 2003-2005, most followed-up to the end of 2008, were randomly selected from the Italian Cancer Registries database. Diabetic status, sex, age, tumor stage, subsite, treatment, morphology, and grade were obtained by consultation of patient clinical records. Poisson multivariable regression models, adjusted for potential confounding variables, were used to estimate hazard ratios (HRs) for all-cause and CRC-specific mortality, according to diabetic status.
  
  
  RESULTS
  A total of 1,039 CRC cases with known fasting glucose or diabetic status, archived in 7 cancer registries, was analyzed. Compared to non-diabetics, diabetics (specific diagnosis or glucose ≥126 mg/dl) were older and less likely to receive adjuvant therapy. Diabetics were at higher risk of all-cause death [HR 1.41; 95 % confidence interval (CI) 1.18-1.70] and CRC death (HR 1.36; 95 % CI 1.11-1.67), with no differences by sex or subsite.
  
  
  CONCLUSIONS
  Diabetes was significantly associated with increased overall and CRC-specific mortality. Our findings indicate that diabetes is a negative prognostic factor for CRC and suggest that in patients with CRC, diabetes prevention and treatments that stabilize the condition and control its complications might reduce mortality. Further studies are required to ascertain the mechanisms linking diabetes to greater mortality in CRC patients.
authors: Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy. francesca.bella@istitutotumori.mi.it
authors: Francesca
authors: F
authors: Bella
authors: Pamela
authors: P
authors: Minicozzi
authors: Adriano
authors: A
authors: Giacomin
authors: Emanuele
authors: E
authors: Crocetti
authors: Massimo
authors: M
authors: Federico
authors: Maurizio
authors: M
authors: Ponz de Leon
authors: Mario
authors: M
authors: Fusco
authors: Rosario
authors: R
authors: Tumino
authors: Lucia
authors: L
authors: Mangone
authors: Orietta
authors: O
authors: Giuliani
authors: Mario
authors: M
authors: Budroni
authors: Milena
authors: M
authors: Sant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology*; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
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