Diabetes mellitus and outcomes of colorectal cancer

Figures & data

Table I.  Baseline characteristics of colorectal cancer patients by diabetes mellitus status

Characteristic	Diabetes (N=97) n (%)	No Diabetes (N=1097) n (%)	p-value
Age (median)	76.2	71.7	<0.001 *
Gender
Male	54 (56)	574 (52)	0.60 †
Female	43 (44)	523 (48)
Cardiac disease
Yes	57 (59)	347 (32)	<0.001 †
No	40 (41)	750 (68)
Pulmonary disease
Yes	13 (13)	110 (10)	0.30 †
No	84 (87)	987 (90)
American Society of Anaesthesiologists			<0.001 ‡
Score (ASA)
1	1 (1)	101 (9)
2	28 (29)	631 (58)
3	57 (59)	318 (29)
4	10 (10)	44 (4)
5	1 (1)	3 (0.3)
Bowel obstruction, without perforation, at presentation
Yes	1 (1)	107 (10)	0.001†
No	96 (99)	990 (90)
Bowel perforation
Spontaneous, outside tumor	6 (6)	32 (3)
Spontaneous, within tumor	1 (1)	12 (1)
Perforation of tumor by surgeon	2 (2)	35 (3)
No perforation	88 (91)	1018 (93)
Location			0.24 *
Coecum-transverse colon	33 (34)	391 (36)
Left flexure-rectosigmoid	39 (40)	354 (32)
Rectum	25 (26)	352 (32)
Stage (TNM)
I	7 (7)	154 (14)	0.66 ‡
II	42 (43)	377 (34)
III	22 (23)	257 (23)
IV	18 (19)	246 (22)
Unknown	8 (8)	63 (6)
Poor differentiation
Yes	15 (15)	200 (18)	0.58 †
No	82 (85)	897 (82)
Mean percentage positive nodes after resection15.5	17.2	0.46 *
Adjuvant chemotherapy
Yes	3 (3)	31 (3)	0.75 †
No	94 (97)	1066 (97)

• By Wilcoxon rank sum*

• By Fisher exact test†

• By Cochran-Armitage trend test ‡

Table II.  Treatment of colorectal cancer patients in relation to diabetes mellitus status

Type of treatment	Diabetes	No diabetes
Best supportive care, no operation	8 (8%)	66 (6%)
Local resection (transanal or endoscopic)	3 (3%)	36 (3%)
Nonresective procedure (stomia or bypass)	6 (6%)	46 (4%)
Palliative resections	15 (15%)	195 (18%)
Major resection, curative intent, microscopic involved circumferential margin	2 (2%)	19 (2%)
Major resection, curative intent, bowel or tumor perforation	1 (1%)	28 (3%)
Curative resection	62 (64%)	707 (64%)
Total	97(100%)	1097(100%)

Figure 1.  Overall survival after major resection with curative intent and after non-curative treatment, in relation to diabetes status.

Table IIIa.  Results of multivariate analysis of overall survival of patients with colorectal cancer

Characteristics	No (%)	Non-adjusted hazard ratio	p-value	Adjusted hazard ratio	p-value
Diabetes mellitus	97 (8.1)	1.55 (1.23 to 1.96)	<0.001	1.36 (1.07 to 1.72) 0.013
Cardiac disease	404 (33.8)	1.55 (1.34 to 1.78)	<0.001	1.27 (1.10 to 1.48)	0.002
Pulmonary disease	123 (10.3)	1.41 (1.14 to 1.74)	0.002	1.28 (1.03 to 1.59)	0.024
Other diseases	502 (42.0)	1.36 (1.19 to 1.56)	<0.001	1.22 (1.06 to 1.41)	0.005
Tumor stage			<0.001		<0.001
I	161 (14)	1	1
II	419 (35)	1.56 (1.20 to 2.02)		1.43 (1.11 to 1.86)
III	279 (23)	2.02 (1.55 to 2.65)		1.90 (1.45 to 2.49)
IV	263 (22)	11.25 (8.56 to14.80)		13.89 (10.5 to 18.3)
Unknown	72 (6)	4.31 (3.06to 6.05)		3.96 (2.81 to 5.57)
Age		1.042 (1.035 to1.050)	<0.001	1.045 (1.038 to1.053)	<0.001

Table IIIb.  Results of multivariate analysis of overall survival after a curative resection for colorectal cancer

Characteristics	No (%)	Non-adjusted hazard ratio	p-value	Adjusted hazard ratio	p-value
Diabetes mellitus	62 (8.1)	1.79 (1.31 to 2.44)	<0.001
Cardiac disease	273 (35.5)	1.96 (1.62 to 2.36)	<0.001	1.39 (1.15 to 1.69)	0.001
Pulmonary disease	72 (9.4)	1.45 (1.08 to 1.95) 0.015	1.41 (1.05 to 1.90)	0.023
Other diseases	335 (43.6)	1.69 (1.40 to 2.04)	<0.001	1.43 (1.19 to 1.73)	<0.001
Tumor stage			0.001		0.006
I	143 (18.6)	1		1
II	390 (50.7)	1.52 (1.16 to 1.99)		1.39 (1.06 to 1.83)
III	236 (30.7)	1.75 (1.31 to 2.33)		1.61 (1.21 to 2.15)
Age		1.069 (1.058 to1.080)	<0.001	1.061 (1.050 to1.073)	<0.001

Figure 2.  Cancer specific survival of 1 194 patients with colorectal cancer, in relation to diabetes status

Table IVa.  Results of multivariate analysis of cancer specific survival of patients with colorectal cancer

Characteristics	n (%)	Adjusted hazard ratio (95% CI)	p-value
Tumor stage
I	161 (14)	1	<0.001
II	419 (35)	2.72 (1.52 to 4.87)
III	279 (23)	6.45 (3.63 to 11.5)
IV	263 (22)	54.5 (30.9 to 96.3)
Unknown	72 (6)	12.6 (6.62 to 23.9)
Age		1.026 (1.018 to 1.035)	<0.001

Table IVb.  Results of multivariate analysis of cancer specific survival after curative resection of colorectal cancer

Characteristics	n (%)	Adjusted hazard ratio (95% CI)	p-value
Tumor stage
I	143 (18.6)	1	<0.001
II	390 (50.7)	2.43 (1.28 to 4.60)
III	236 (30.7)	5.42 (2.88 to 10.2)
Age		1.027 (1.012 to 1.044)	<0.001