Elevated HbA1c Is an Independent Predictor of Aggressive Clinical Behavior in Patients with Colorectal Cancer: A Case-Control Study

Department of Internal Medicine, Dallas Veterans Affairs Medical Center, 4500 S. Lancaster Road (111B1), Dallas, TX 75216, USA.
Digestive Diseases and Sciences (Impact Factor: 2.61). 05/2008; 53(9):2486-94. DOI: 10.1007/s10620-008-0264-4
Source: PubMed


The aim of this study was to seek an association between the control of type 2 diabetes mellitus (T2DM), as determined by hemoglobin A1c (HbA1c) levels, and the outcome of colorectal cancer (CRC).
We performed a retrospective review of patients with T2DM who had CRC diagnosed between 1997 and 2001. We defined well-controlled T2DM as HbA1c < 7.5% and poorly controlled T2DM as HbA1c > or = 7.5%. A group of age- and gender-matched patients who had CRC without T2DM were used as controls. Forty clinical factors were reviewed, and those associated with poor clinical outcome in each group were examined by univariate analysis (UA) and by the maximum likelihood analysis of logistic regression to determine the independent predictors of cancer outcome.
We identified 155 patients with T2DM and CRC, and 114 control patients who had CRC without T2DM. We found no significant differences in any clinical factor by UA between the patients with well-controlled T2DM and the patients who had CRC without T2DM. Compared to both of those patients groups, in contrast, the patients with poorly controlled T2DM had more right-sided CRCs (P = 0.04, OR = 2, 95% CI = 1-4.1), more advanced CRCs (P = 0.02, OR = 2.1, 95% CI = 1-4.4), a younger age of presentation (P = 0.05), greater use of exogenous insulin (P = 0.002), and a poorer 5-year survival (P = 0.001) by UA. Logistic regression showed that poorly controlled T2DM independently predicted the early onset of CRC, a more advanced stage at the time of presentation, poorer 5-year survival, and an increased incidence of right-sided CRCs.
In patients with T2DM who have CRC, poor glycemic control is associated with a clinically aggressive course for the cancer.

8 Reads
  • Source
    • "Elevated HgA1c levels has been associated with increased risk of many cancers including breast, genitourinary and gastrointestinal cancers (Rinaldi et al., 2008). Siddiqui et al. (2008) reported in a case-control study that elevated HgA1c is an independent predictor of aggressive clinical behavior in patients with colorectal cancer. Impaired glucoe intolerance as measured by HgA1c was found to be significantly increased in endometrial cancer cases when compared to patients with other cancer (Levran et al., 1984). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Hemoglobin A1c(HgA1c) is a marker of poor gylcemic control and elevation HgA1c is associatedwith increased risk of many cancers. We aimed to determine the HgA1c levels in endometrial cancer cases and any relationship with stage and grade of disease. Materials and Methods: A retrospective data review was performed between June 2011 and October 2012 at a tertiary referral center in Turkey. The study included 35 surgically staged endometrial cancer patients and 40 healthy controls. Preoperative HgA1c levels drawn within 3 months before surgery were compared. Also the relationships between HgA1c levels and stage, grade and hystologic type of cancer cases were evaluated. Results: The mean HgA1c levels were statistically significantly higher at 6.19±1.44 in endometrial cancer cases than the 5.61±0.58 in controls (p=0.027). With endometrial cancer cases, the mean HgA1c level was found to be 6.62±1.40 for stage I and 6.88±1.15 for stages II-IV (p=0.07). The figures were 6.74±1.65 for endometrioid and 6.63±1.41 for non-endometrioid type tumors (p=0.56). Mean HgA1c levels of 6.72±1.14 for grade 1 and 6.62±1.42 for grade 2-3 were observed (p=0.57). Conclusions: HgA1c levels in endometrial cancer patients were statistically higher than healthy controls. However, HgA1c did not show any significant correlation with stage, grade and histologic type in endometrial cancer cases.
    Asian Pacific journal of cancer prevention: APJCP 03/2015; 16(5):1817-1820. DOI:10.7314/APJCP.2015.16.5.1817 · 2.51 Impact Factor
  • Source
    • "Of them, one study (Huang et al, 2011) found a significant increased risk for colon cancer-specific mortality. Two (van de Poll-Franse et al, 2012; Bella et al, 2013) found a significantly increased risk for only rectal cancer patients but not for colon cancer, and one (Siddiqui et al, 2008) found an association between poorly controlled pre-existing diabetes and the risk of death attributed to colorectal cancer. Other studies found no significant association between diabetes and subsequent death from colorectal cancer. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Epidemiological studies have reported that diabetes significantly increases overall mortality in patients with colorectal cancer. However, it is unclear whether diabetes increases colorectal cancer-specific mortality. We used the US Surveillance Epidemiology and End Results (SEER) database linked with Medicare claims data to assess the influence of pre-existing diabetes on prognosis of patients with colorectal cancer. Methods: Data from 61 213 patients aged 67 or older with colorectal cancer diagnosed between 2003 and 2009 were extracted and prospectively followed through the date of death or the end of 2012 if the patient was still alive. Diabetes cases with and without complications were identified based on an algorithm developed for the Chronic Condition Data Warehouse (CCW). Cox models were used to estimate hazard ratios (HRs) for total mortality. The proportional subdistribution hazards model proposed by Fine and Gray was used to estimate HRs for colorectal cancer-specific mortality. Results: Compared with patients without diabetes, colorectal cancer patients with pre-existing diabetes had significantly higher risk of overall mortality (HR=1.20, 95 % confidence interval (95% CI): 1.17–1.23). The HR for overall mortality was more pronounced for patients who had diabetes with complications (HR=1.50, 95% CI: 1.42–1.58). However, diabetes was not associated with increased colorectal cancer-specific mortality after accounting for non-colorectal cancer outcomes as competing risk. Conclusions: Pre-existing diabetes increased risk of total mortality among patients with colorectal cancer, especially among cancer patients who had diabetes with complications. The increased risk of total mortality associated with diabetes was primarily explained by increased cardiovascular-specific mortality, not by increased colorectal cancer-specific mortality.
    British Journal of Cancer 02/2014; 110(7). DOI:10.1038/bjc.2014.68 · 4.84 Impact Factor
  • Source
    • "The impact of DM on pathologic parameters has been evaluated in colorectal cancer where it is suggested to influence pathologic stage [26] and in breast cancer where DM is associated with estrogen receptor negativity. [27,28] Macrovascular invasion [24] and microvascular invasion [25] have been identified as key negative prognostic indicators in HCC, findings which were echoed in the current study. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Diabetes mellitus (DM) is identified as a negative prognostic indicator in hepatocellular carcinoma (HCC), though the basis for this is unknown. Methods This is a retrospective analysis of a prospectively collected database of 191 HCC patients treated at the University of Rochester Medical Center (URMC) with orthotopic liver transplantation between 1998–2008. Clinical characteristics were compared between patients with and without DM prior to liver transplantation and logistic regression analyses were conducted to assess the effect of DM on clinical outcomes including vascular invasion. Results Eighty-four of 191 (44%) transplanted patients had DM at time of transplantation. An association of DM with invasive disease was found among transplanted HCC patients where histologically confirmed macrovascular invasion was found in 20.2% (17/84) of diabetics compared to 9.3% of non-diabetics (10/107) (p=0.032). This difference also remained significant when adjusting for tumor size, number of nodules, age, obesity and etiologic risk factors in multivariate logistic regression analysis (OR=3.2, p=0.025). Conclusions DM is associated with macrovascular invasion among a cohort of transplanted HCC patients.
    BMC Gastroenterology 01/2013; 13(1):9. DOI:10.1186/1471-230X-13-9 · 2.37 Impact Factor
Show more