Impact of Diabetes Mellitus on the Prognosis of Patients with Oral Squamous Cell Carcinoma: A Retrospective Cohort Study
Diabetes mellitus (DM) is a prevalent chronic metabolic disease reported to affect the treatment outcomes of malignancies. This study explores the impact of diabetes on the prognosis of oral squamous cell carcinoma (OSCC).
Materials and Methods
Clinicopathological characteristics and survival in terms of overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) of patients with OSCC who underwent surgical intervention at the Taipei Veterans General Hospital between 2002 and 2005 were stratified by diabetic status and compared.
Patients with DM tend to have a lower OS, RFS, and CSS compared with nondiabetics (adjusted hazard ratio [HR] = 2.22, 2.42, and 2.16, respectively) even in less aggressive tumor stages (stage I and II). In advanced tumors, diabetic patients who were not prescribed adjuvant therapy had a significantly higher recurrence rate than nondiabetic patients (HR = 2.66). However, there was no significant difference in treatment outcome in patients with locally advanced tumors amenable to receive adjuvant therapy, even with the delayed initiation of adjuvant therapy in the DM group (49.1 ± 22.3 days vs. 40.0 ± 16.6 days, P = .04). DM was also associated with a higher frequency of perineural invasion (adjusted odds ratio [OR] = 2.53).
DM status could be a prognostic factor for OSCC, particularly for its effect in the survival and perineural invasion. Although diabetes-associated comorbidities may impair decision making toward less aggressive therapeutic modality, adjuvant treatment may be essential for DM patients to improve their survival.
- 18.Parkin DM, Whelan SL, Ferlay J, Teppo L, Thomas DB. Cancer Incidence in Five Continents. Vol. VIII: IARC Scientific Publication No. 155; 2003.Google Scholar
- 20.Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. Geneva: World Health Organization; 2006.Google Scholar
- 21.Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M, eds. American Joint Committee on Cancer: AJCC cancer staging manual. 6th ed. New York: Springer; 2002.Google Scholar
- 24.Mulder GD. Wound Care Communications Network. Clinician’s Pocket Guide to Chronic Wound Repair. PA: Springhouse; 1998. p. 58–67.Google Scholar
- 28.2002 Survey on the Prevalence of Hypertension, Hyperglycemia and Hyperlipidemia in Taiwan. Bureau of Health Promotion DoH, Executive Yuan, R.O.C. (Taiwan), ed., 2003.Google Scholar
- 53.Kotelevets L, Noe V, Bruyneel E, Myssiakine E, Chastre E, Mareel M, et al. Inhibition by platelet-activating factor of Src- and hepatocyte growth factor-dependent invasiveness of intestinal and kidney epithelial cells. Phosphatidylinositol 3′-kinase is a critical mediator of tumor invasion. J Biol Chem. 1998;273:14138–45.CrossRefPubMedGoogle Scholar