Review

Digestive Diseases and Sciences

, Volume 55, Issue 7, pp 1839-1851

First online:

Colorectal Cancer Outcomes, Recurrence, and Complications in Persons With and Without Diabetes Mellitus: A Systematic Review and Meta-Analysis

  • Kelly B. SteinAffiliated withJohns Hopkins School of MedicineJohns Hopkins Bloomberg School of Public HealthDivision of General Internal Medicine, Johns Hopkins School of Medicine
  • , Claire F. SnyderAffiliated withJohns Hopkins School of MedicineJohns Hopkins Bloomberg School of Public HealthDivision of General Internal Medicine, Johns Hopkins School of Medicine
  • , Bethany B. BaroneAffiliated withJohns Hopkins Bloomberg School of Public Health
  • , Hsin-Chieh YehAffiliated withJohns Hopkins School of MedicineJohns Hopkins Bloomberg School of Public HealthDivision of General Internal Medicine, Johns Hopkins School of Medicine
  • , Kimberly S. PeairsAffiliated withJohns Hopkins School of MedicineDivision of General Internal Medicine, Johns Hopkins School of Medicine
  • , Rachel L. DerrAffiliated withJohns Hopkins School of MedicineCenter for Medicine Endocrinology and Diabetes
  • , Antonio C. WolffAffiliated withDepartment of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University Medical Institutions
  • , Frederick L. BrancatiAffiliated withJohns Hopkins School of MedicineJohns Hopkins Bloomberg School of Public HealthDivision of General Internal Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research Email author 

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Abstract

Background

Diabetes mellitus increases the risk of incident colorectal cancer, but it is less clear if pre-existing diabetes mellitus influences mortality outcomes, recurrence risk, and/or treatment-related complications in persons with colorectal cancer.

Methods

We performed a systematic review and meta-analysis comparing colorectal cancer mortality outcomes, cancer recurrence, and treatment-related complications in persons with and without diabetes mellitus. We searched MEDLINE and EMBASE through October 1, 2008, including hand-searching references of qualifying articles. We included studies in English that evaluated diabetes mellitus and cancer treatment outcomes, prognosis, and/or mortality. The initial search identified 8,208 titles, of which 15 articles met inclusion criteria. Each article was abstracted by one author using a standardized form and re-reviewed by another author for accuracy. Authors graded quality based on pre-determined criteria.

Results

We found significantly increased short-term perioperative mortality in persons with diabetes mellitus. In the meta-analysis of long-term mortality, persons with diabetes mellitus had a 32% increase in all-cause mortality compared to those without diabetes mellitus (95% CI: 1.24, 1.41). Although data on other outcomes are limited, available studies suggest that pre-existing diabetes mellitus predicts increased risk of some post-operative complications as well as 5-year cancer recurrence. In contrast, there is little evidence that diabetes confers increased risk for long-term cancer-specific mortality.

Conclusions

Patients with colorectal cancer and pre-existing diabetes mellitus have an increased risk of short- and long-term mortality. Future research should determine whether improvements in prevention and treatment of diabetes mellitus will improve outcomes for colorectal cancer patients.

Keywords

Colorectal carcinoma Diabetes mellitus Mortality Treatment outcome Fatal outcome