title: Impact of diabetes mellitus on oncological outcomes after radical hysterectomy for early stage cervical cancer.
abstract: OBJECTIVE
  To evaluate the relationship between type 2 diabetes mellitus (DM) and oncological outcomes in early stage cervical cancer patients who underwent radical surgical resection.
  
  
  METHODS
  Patients with early stage cervical cancer diagnosed between 2001 and 2014 were retrospectively enrolled. We assessed the outcomes of 402 non-DM and 42 DM patients with cervical cancer. We tested the prognostic value of DM via Cox proportional hazard modeling.
  
  
  RESULTS
  Patients with DM were more likely to be older and overweight. In the DM group, 20 and 22 patients were and were not taking metformin, respectively. The 5-year recurrence-free survival (RFS) and 5-year overall survival (OS) rate for the whole study population were 88.49% and 96.34%, respectively. In the DM group, there was no evidence that metformin affected the RFS (p=0.553) or the OS (p=0.429). In multivariate analysis, age (p=0.007), histology (p=0.006), and deep stromal invasion (p=0.007) were independent adverse prognostic factors for RFS. There was a borderline significant association of increased RFS with DM (p=0.051). However, a time-varying-effect Cox model revealed that the DM was associated with a worse RFS (hazard ratio, 11.15; 95% CI, 2.00 to 62.08, p=0.022) after 5 years. DM (p=0.008), age (p=0.009), and node status (p=0.001) were the only 3 independent prognostic factors for OS.
  
  
  CONCLUSIONS
  Early stage cervical cancer patients with type 2 DM have a poorer oncological outcome than patients without DM.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Prince of Songkla University Faculty of Medicine, Songkhla, Thailand.
authors.forename: Ingporn
authors.identifier: http://orcid.org/0000-0002-5771-2557
authors.initials: I
authors.lastname: Jiamset
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Prince of Songkla University Faculty of Medicine, Songkhla, Thailand. hjitti@yahoo.com.
authors.forename: Jitti
authors.identifier: http://orcid.org/0000-0002-0640-6824
authors.initials: J
authors.lastname: Hanprasertpong
mesh_terms: D000328:Adult; D000367:Age Factors; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007044:Hysterectomy; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin
keywords: Diabetes Mellitus; Hysterectomy; Metformin; Prognosis; Uterine Cervical Neoplasms