Journal of Cancer Research and Clinical Oncology

, Volume 139, Issue 8, pp 1303–1310 | Cite as

Impact of diabetes on overall and cancer-specific mortality in colorectal cancer patients

  • Francesca Bella
  • Pamela Minicozzi
  • Adriano Giacomin
  • Emanuele Crocetti
  • Massimo Federico
  • Maurizio Ponz de Leon
  • Mario Fusco
  • Rosario Tumino
  • Lucia Mangone
  • Orietta Giuliani
  • Mario Budroni
  • Milena Sant
Original Paper



Diabetes is associated with increased risk of developing colorectal cancer (CRC), but its effect on overall and cancer-specific mortality in CRC patients has been little investigated. The aim of this study was to assess the influence of diabetes on overall and cancer-specific mortality in Italian CRC patients.


Cases of adult (≥15 years) CRC, diagnosed in 2003–2005, most followed-up to the end of 2008, were randomly selected from the Italian Cancer Registries database. Diabetic status, sex, age, tumor stage, subsite, treatment, morphology, and grade were obtained by consultation of patient clinical records. Poisson multivariable regression models, adjusted for potential confounding variables, were used to estimate hazard ratios (HRs) for all-cause and CRC-specific mortality, according to diabetic status.


A total of 1,039 CRC cases with known fasting glucose or diabetic status, archived in 7 cancer registries, was analyzed. Compared to non-diabetics, diabetics (specific diagnosis or glucose ≥126 mg/dl) were older and less likely to receive adjuvant therapy. Diabetics were at higher risk of all-cause death [HR 1.41; 95 % confidence interval (CI) 1.18–1.70] and CRC death (HR 1.36; 95 % CI 1.11–1.67), with no differences by sex or subsite.


Diabetes was significantly associated with increased overall and CRC-specific mortality. Our findings indicate that diabetes is a negative prognostic factor for CRC and suggest that in patients with CRC, diabetes prevention and treatments that stabilize the condition and control its complications might reduce mortality. Further studies are required to ascertain the mechanisms linking diabetes to greater mortality in CRC patients.


Colorectal cancer Cancer-specific mortality Survival Diabetes Prognosis 



We thank the Compagnia di San Paolo, the Fondazione Cariplo, Italy and the Centro Nazionale per la Prevenzione e il Controllo delle Malattie of the Italian Ministry of Health for supporting this research; Chiara Margutti for secretarial assistance; Carlotta Buzzoni and AIRTUM for contributing to study design and providing data; and Don Ward for help with the English.

Conflict of interest

We declare that we have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Francesca Bella
    • 1
  • Pamela Minicozzi
    • 1
  • Adriano Giacomin
    • 2
  • Emanuele Crocetti
    • 3
  • Massimo Federico
    • 4
  • Maurizio Ponz de Leon
    • 5
  • Mario Fusco
    • 6
  • Rosario Tumino
    • 7
  • Lucia Mangone
    • 8
  • Orietta Giuliani
    • 9
  • Mario Budroni
    • 10
  • Milena Sant
    • 1
  1. 1.Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive MedicineFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  2. 2.Piedmont Cancer RegistryProvince of Biella (CPO), Epidemiology UnitBiellaItaly
  3. 3.Tuscany Cancer RegistryClinical and Descriptive Epidemiology Unit, ISPOFlorenceItaly
  4. 4.Modena Cancer Registry, Department of Oncology, Hematology and Respiratory DiseasesUniversity of Modena and Reggio EmiliaModenaItaly
  5. 5.Division of Internal Medicine, Department of Internal Medicine and Specialized Colorectal Cancer RegistryUniversity of Modena and Reggio EmiliaModenaItaly
  6. 6.Campania Cancer RegistryLocal Health Unit Napoli 3, SouthBrusciano, NapoliItaly
  7. 7.Cancer Registry and Histopathology Unit, MP Arezzo Civic HospitalProvincial Health UnitRagusaItaly
  8. 8.Statistical, Quality and Clinical Studies UnitIRCCS Arcispedale Santa Maria NuovaReggio EmiliaItaly
  9. 9.Romagna Cancer RegistryIRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei TumoriMeldola, ForlìItaly
  10. 10.Sassari Cancer RegistryEpidemiology Unit, Local Health Unit 1SassariItaly

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