title: Colorectal cancer: Histopathologic differences in tumor characteristics between patients with and without diabetes.
abstract: BACKGROUND
  Current literature suggests that diabetes is a possible predictor of risk and worse outcome in colorectal cancer (CRC). The objective of this study was to explore if there are histopathologic differences in CRC between populations with and without diabetes.
  
  
  METHODS
  Retrospective analysis was done on 534 patients with CRC. Patients were divided into diabetic and nondiabetic subgroups. Data were collected for lymphovascular invasion, tumor location, depth invasion, staging, level of differentiation, histologic type, and presence of tumor components (mucinous, signet ring, or neuroendocrine).
  
  
  RESULTS
  Univariately, patients with diabetes had deeper tumor invasion, greater lymphovascular invasion, and higher TNM staging (OR and 95% CI, 2.06 [1.37, 3.10], 2.52 [1.74, 3.63], and 2.45 [1.70, 3.52], respectively; P < .001). Covariate adjustment retained the significant effect of diabetes on tumor characteristics (P < .005). Multivariable adjustment significantly linked diabetes with signet ring cell carcinoma (log odds, 11.40 ± 5.28; P = .03) and tumor components (log odds, 0.58 ± 0.25; P = .02). Patients with diabetes with hyperlipidemia had more well-differentiated tumors (log odds, -0.96 ± 0.47; P = .04). Transverse tumors were more common in patients with diabetes (log odds, 1.74 ± 0.72; P = .02).
  
  
  CONCLUSIONS
  Patients with diabetes had worse histopathologic CRC features. Hyperinsulinemia, insulinlike growth factor receptor activation, and hyperglycemia in diabetes can activate mitogenic pathways stimulating proliferation, invasion, angiogenesis, and metastasis. Future research is needed to identify responsible pathways for targeted therapy and to examine the role of better glycemic control and treatment in patients with CRC and diabetes.
authors.affiliation: Department of Internal Medicine, Mount Sinai School of Medicine (St Joseph's Regional Medical Center) Program, Paterson, NJ. Electronic address: sharmaan@sjhmc.org.
authors.forename: Anurag
authors.initials: A
authors.lastname: Sharma
authors.affiliation: St George's University School of Medicine, Grenada, West Indies.
authors.forename: Hanyann
authors.initials: H
authors.lastname: Ng
authors.affiliation: Department of Internal Medicine, Mount Sinai School of Medicine (St Joseph's Regional Medical Center) Program, Paterson, NJ.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Internal Medicine, Mount Sinai School of Medicine (St Joseph's Regional Medical Center) Program, Paterson, NJ.
authors.forename: Kunal
authors.initials: K
authors.lastname: Teli
authors.affiliation: Department of Internal Medicine, Mount Sinai School of Medicine (St Joseph's Regional Medical Center) Program, Paterson, NJ.
authors.forename: Jeewanjot
authors.initials: J
authors.lastname: Randhawa
authors.affiliation: Department of Internal Medicine, Mount Sinai School of Medicine (St Joseph's Regional Medical Center) Program, Paterson, NJ; Department of Internal Medicine, New York Medical College, Valhalla, NY.
authors.forename: James
authors.initials: J
authors.lastname: Record
authors.affiliation: Department of Hematology and Oncology, Department of Medicine, St Joseph's Regional Medical Center, Paterson, NJ; Department of Hematology and Oncology, Seton Hall University, School of Health and Medical Sciences, South Orange, NJ.
authors.forename: Michael
authors.initials: M
authors.lastname: Maroules
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000150:complications* / Q000473:pathology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Depth; Invasion; Lymphovascular; Signet-ring; Staging