title: 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.
  
  
  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).
  
  
  CONCLUSIONS
  In Asian patients with early cervical cancer, DM is an independent unfavorable prognostic factor influencing both OS and CSS, even after curative treatments.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China; Departments of Oncology, Internal Medicine, and Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Graduate Institute of Oncology, College of Medicine, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, Taipei, Taiwan, Republic of China; Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan, Republic of China; Taiwan Cancer Registry, Taipei, Taiwan, Republic of China.
authors.forename: Hung-Yang
authors.initials: HY
authors.lastname: Kuo
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China; Departments of Oncology, Internal Medicine, and Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Graduate Institute of Oncology, College of Medicine, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, Taipei, Taiwan, Republic of China; Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan, Republic of China; Taiwan Cancer Registry, Taipei, Taiwan, Republic of China.
authors.forename: Zhong-Zhe
authors.initials: ZZ
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China; Departments of Oncology, Internal Medicine, and Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Graduate Institute of Oncology, College of Medicine, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, Taipei, Taiwan, Republic of China; Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan, Republic of China; Taiwan Cancer Registry, Taipei, Taiwan, Republic of China.
authors.forename: Raymond
authors.initials: R
authors.lastname: Kuo
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China; Departments of Oncology, Internal Medicine, and Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Graduate Institute of Oncology, College of Medicine, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, Taipei, Taiwan, Republic of China; Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan, Republic of China; Taiwan Cancer Registry, Taipei, Taiwan, Republic of China.
authors.forename: Wen-Yi
authors.initials: WY
authors.lastname: Shau
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China; Departments of Oncology, Internal Medicine, and Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Graduate Institute of Oncology, College of Medicine, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, Taipei, Taiwan, Republic of China; Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan, Republic of China; Taiwan Cancer Registry, Taipei, Taiwan, Republic of China.
authors.forename: Chiu-Lin
authors.initials: CL
authors.lastname: Lai
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China; Departments of Oncology, Internal Medicine, and Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Graduate Institute of Oncology, College of Medicine, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, Taipei, Taiwan, Republic of China; Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan, Republic of China; Taiwan Cancer Registry, Taipei, Taiwan, Republic of China.
authors.forename: Yen-Yun
authors.initials: YY
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China; Departments of Oncology, Internal Medicine, and Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Graduate Institute of Oncology, College of Medicine, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, Taipei, Taiwan, Republic of China; Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan, Republic of China; Taiwan Cancer Registry, Taipei, Taiwan, Republic of China.
authors.forename: Yu-Yun
authors.initials: YY
authors.lastname: Shao
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China; Departments of Oncology, Internal Medicine, and Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Graduate Institute of Oncology, College of Medicine, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, Taipei, Taiwan, Republic of China; Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan, Republic of China; Taiwan Cancer Registry, Taipei, Taiwan, Republic of China.
authors.forename: Chiun
authors.initials: C
authors.lastname: Hsu
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China; Departments of Oncology, Internal Medicine, and Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Graduate Institute of Oncology, College of Medicine, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, Taipei, Taiwan, Republic of China; Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan, Republic of China; Taiwan Cancer Registry, Taipei, Taiwan, Republic of China.
authors.forename: Wen-Fan
authors.initials: WF
authors.lastname: Cheng
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China; Departments of Oncology, Internal Medicine, and Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Graduate Institute of Oncology, College of Medicine, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, Taipei, Taiwan, Republic of China; Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan, Republic of China; Taiwan Cancer Registry, Taipei, Taiwan, Republic of China.
authors.forename: Ann-Lii
authors.initials: AL
authors.lastname: Cheng
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China; Departments of Oncology, Internal Medicine, and Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Graduate Institute of Oncology, College of Medicine, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, Taipei, Taiwan, Republic of China; Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan, Republic of China; Taiwan Cancer Registry, Taipei, Taiwan, Republic of China chihyang@ntu.edu.tw mslai@cph.ntu.edu.tw.
authors.forename: James Chih-Hsin
authors.initials: JC
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China; Departments of Oncology, Internal Medicine, and Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Graduate Institute of Oncology, College of Medicine, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, Taipei, Taiwan, Republic of China; Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan, Republic of China; Taiwan Cancer Registry, Taipei, Taiwan, Republic of China chihyang@ntu.edu.tw mslai@cph.ntu.edu.tw.
authors.forename: Mei-Shu
authors.initials: MS
authors.lastname: Lai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000378:metabolism / Q000473:pathology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality / Q000473:pathology
keywords: Cancer registry; Cancer-specific survival; Cervical cancer; Diabetes mellitus; Prognosis