title: Colon cancer modulation by a diabetic environment: A single institutional experience.
abstract: BACKGROUND
  Multiple observational studies suggest an increased risk of colon cancer in patients with diabetes mellitus (DM). This can theoretically be the result of an influence of the diabetic environment on carcinogenesis or the tumor biologic behavior.
  
  
  OBJECTIVE
  To gain insight into the influence of a diabetic environment on colon cancer characteristics and outcomes.
  
  
  METHODS
  Retrospective analysis of clinical records in an academic tertiary care hospital with detailed analysis of 81 diabetic patients diagnosed of colon cancer matched with 79 non-diabetic colon cancer patients. The impact of streptozotocin-induced diabetes on the growth of colon cancer xenografts was studied in mice.
  
  
  RESULTS
  The incidence of DM in 1,137 patients with colorectal cancer was 16%. The diabetic colon cancer cases and non-diabetic colon cancer controls were well matched for demographic and clinical variables. The ECOG Scale Performance Status was higher (worse) in diabetics (ECOG ≥1, 29.1% of controls vs 46.9% of diabetics, p = 0.02), but no significant differences were observed in tumor grade, adjuvant therapy, tumor site, lymphovascular invasion, stage, recurrence, death or cancer-related death. Moreover, no differences in tumor variables were observed between patients treated or not with metformin. In the xenograft model, tumor growth and histopathological characteristics did not differ between diabetic and nondiabetic animals.
  
  
  CONCLUSIONS
  Our findings point towards a mild or negligible effect of the diabetes environment on colon cancer behavior, once cancer has already developed.
authors.affiliation: Radiation Oncology, Oncohealth Institute, IIS-Fundacion Jimenez Diaz- UAM, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Prieto
authors.affiliation: Translational Oncology Division, Oncohealth Institute, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Del Puerto-Nevado
authors.affiliation: Renal, Vascular and Diabetes Research Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.|Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Gonzalez
authors.affiliation: Bone and Mineral Metabolism Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Portal-Nuñez
authors.affiliation: Pathology Department, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Zazo
authors.affiliation: Department of Genetics, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Corton
authors.affiliation: Department of Genetics, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Minguez
authors.affiliation: Renal, Vascular and Diabetes Research Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.|Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Gomez-Guerrero
authors.affiliation: Health Information Management Department, Fundacion Jimenez Diaz, Madrid. Spain.
authors.forename: Jose Miguel
authors.initials: JM
authors.lastname: Arce
authors.affiliation: Renal, Vascular and Diabetes Research Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.
authors.forename: Ana Belen
authors.initials: AB
authors.lastname: Sanz
authors.affiliation: Renal, Vascular and Diabetes Research Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.|Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Mas
authors.affiliation: Radiation Oncology, Oncohealth Institute, IIS-Fundacion Jimenez Diaz- UAM, Madrid, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Aguilera
authors.affiliation: Immunoallergy and proteomics Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: Alvarez-Llamas
authors.affiliation: Bone and Mineral Metabolism Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Esbrit
authors.affiliation: Renal, Vascular and Diabetes Research Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ortiz
authors.affiliation: Department of Genetics, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Ayuso
authors.affiliation: Renal, Vascular and Diabetes Research Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.|Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Egido
authors.affiliation: Pathology Department, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Rojo
authors.affiliation: Translational Oncology Division, Oncohealth Institute, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Garcia-Foncillas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D063646:Carcinogenesis; D049109:Cell Proliferation; D002471:Cell Transformation, Neoplastic; D003110:Colonic Neoplasms / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D048909:Diabetes Complications / Q000453:epidemiology / Q000473:pathology*; D018450:Disease Progression; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D008297:Male; D051379:Mice; D008875:Middle Aged; D012189:Retrospective Studies; D063128:Tertiary Health Care