title: Prognostic value of glycated hemoglobin in colorectal cancer.
abstract: OBJECTIVE
  To investigate the clinical significance of routinely used glycemic parameters in a cohort of colorectal cancer (CRC) patients.
  
  
  METHODS
  Pre-treatment fasting blood glucose, insulin, HbA1cand homeostasis model of risk assessment (HOMA-IR) were retrospectively evaluated in a case-control study of 224 CRC and 112 control subjects matched for sex, obesity and diabetes frequency and blood lipid profile. Furthermore, the prognostic value of routinely used glycemic parameters towards progression-free (PFS) and overall survival (OS) was prospectively evaluated.
  
  
  RESULTS
  Fasting blood glucose, insulin, HOMA-IR and HbA1c(allP< 0.0001) levels were higher in non-diabetic CRC patients compared with obesity-matched controls. All parameters were associated with increased CRC risk at ROC analysis, but no relationship with clinical-pathological variables or survival outcomes was observed for glycemia, insulinemia or HOMA-IR. Conversely, advanced CRC stage (P= 0.018) was an independent predictor of increased HbA1clevels, which were also higher in patients who had disease progression compared with those who did not (P= 0.05). Elevated HbA1clevels showed a negative prognostic value both in terms of PFS (HR = 1.24) and OS (HR = 1.36) after adjustment for major confounders, which was further confirmed in a subgroup analysis performed after exclusion of diabetic patients.
  
  
  CONCLUSIONS
  HbA1cmight have a negative prognostic value in CRC, thus suggesting that glycemic metabolic markers should be carefully monitored in these patients, independently of overt diabetes.
authors.affiliation: Patrizia Ferroni, Fiorella Guadagni, San Raffaele Roma Open University, 00166 Rome, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Ferroni
authors.affiliation: Patrizia Ferroni, Fiorella Guadagni, San Raffaele Roma Open University, 00166 Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Formica
authors.affiliation: Patrizia Ferroni, Fiorella Guadagni, San Raffaele Roma Open University, 00166 Rome, Italy.
authors.forename: David
authors.initials: D
authors.lastname: Della-Morte
authors.affiliation: Patrizia Ferroni, Fiorella Guadagni, San Raffaele Roma Open University, 00166 Rome, Italy.
authors.forename: Jessica
authors.initials: J
authors.lastname: Lucchetti
authors.affiliation: Patrizia Ferroni, Fiorella Guadagni, San Raffaele Roma Open University, 00166 Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Spila
authors.affiliation: Patrizia Ferroni, Fiorella Guadagni, San Raffaele Roma Open University, 00166 Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: D'Alessandro
authors.affiliation: Patrizia Ferroni, Fiorella Guadagni, San Raffaele Roma Open University, 00166 Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Riondino
authors.affiliation: Patrizia Ferroni, Fiorella Guadagni, San Raffaele Roma Open University, 00166 Rome, Italy.
authors.forename: Fiorella
authors.initials: F
authors.lastname: Guadagni
authors.affiliation: Patrizia Ferroni, Fiorella Guadagni, San Raffaele Roma Open University, 00166 Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Roselli
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000378:metabolism* / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D001786:Blood Glucose / Q000378:metabolism*; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000378:metabolism* / Q000401:mortality; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism; D018572:Disease-Free Survival; D005260:Female; D018149:Glucose Intolerance / Q000453:epidemiology / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology / Q000378:metabolism; D050177:Overweight / Q000453:epidemiology / Q000378:metabolism; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Colorectal cancer; Glycated hemoglobin; Insulin resistance; Prognostic value; Type 2 diabetes