The Risk Analysis Of Digestive System Carcinoma And Diabetes Mellitus And Comparision With Related Risk Factors

Objective: Understand the major risk factors of digestive system carcinoma . Make clear that whether diabetes mellitus(DM) causes the digestive system carcinoma [includes Colorectal carcinoma , Pancreatic carcinoma(PC) , Primary liver carcinoma(PLC)]. Provide some ideas to prevent digestive system carcinoma. Methods : We conducted the hospital-based case-control study to compare cases of 864 Colorectal carcinoma patients ( 147 Colon carcinoma patients and 717 Rectal carcinoma patients), 147 Pancreatic carcinoma patients and 848 Primary liver carcinoma patients in the China-Japan Union Hospital of Jilin University from January 1^st, 2000 to May 1^st, 2004 with 5078 control cases of the non-carcinoma patients in Respiration Department , Cardiaology Department, Kidney-rheumatism Department , Department of Ophthalmology, Urinary Surgery. According to the new proposals for diabetes mellitus diagnose standards , made by American Diabetes Association(ADA) in 1997, they are divided into diabetes team and non-diabetes team, to analyse the effect of DM on the digestive system carcinoma. Statistical method: mono-factor analysis testified by x²-check, calculates the OR of DM as an exposed factor to colorectal carcinoma, PC and PLC and estimates the relative risk as well as 95% CI. Results: Among the digestive system carcinoma patients hospitalized in China-Japan Union Hospital from January 1st, 2000 to May 31st, 2004 (864 colorectal carcinoma patients,147 PC patients and 848 PLC patients) , the OR of colorectal carcinoma in the diabetes team is 4.48; the OR of PC is 37.42, and the OR of PLC is 9.77. Among male patients , the OR of colorectal carcinoma in paitents who have diabetes is 4.83, the OR of PC in paitents who have diabetes is 35.79, the OR of PLC in paitents who have diabetes is 10.03; while among female patients the OR of colorectal carcinoma is 4.95; the OR of PC is 47.61, the OR PLC is 8.62. There is not obvious difference between sexes. The OR of having colorectal carcinoma in patients who suffering DM less than 5 years is 2.00, that of those suffering DM for 5 to 10 years is 5.79, that of those suffering DM for 10 to 15 years is.9.97, that of those suffering DM more than 15 years is 1.68(P>0.05). The OR of having PC in patients who suffering DM less than 2 years is 38.01, that of those suffering DM for 2 to 5 years is 33.01, that of those suffering DM more than 5 years is 38.22. The OR of having PLC in patients who suffering DM less than 5 years is 3.15, that of those suffering DM for 5 to 10 years is 12.09, that of those suffering DM more than 10 yearsis 15.77. the OR of the colorectal carcinoma patients who are suffering DM and have lymph nodes or other organs metastasis is 4.76. There is no obvious correlation between the location of PC and DM(P>0.05). The OR of having PLC in patients who are suffering DM but aren't infected with HBV/HCV and addicted to alcohol is 2.32, the OR of having PLC in patients who are suffering DM and are infected with HBV/HCV but aren't addicted to alcohol was11.84, that of patients who are suffered DM and addicted to alcohol but aren't infected with HBV/HCV is 5.51, that of those suffering DM , infected with HBV/HCV and addicted to alcohol is 15.09. Discussion: The incidence rate and mortality rate of digestive system carcinoma rank the first in the malignant tumor ,and have a trend to increase, threatening human's health and lives, and the study on its etiology is still the focus of our study. Meanwhile, with the improvement of living standard, the incidence of diabetes is increasing, therefore more and more scholars begin to pay close attention to the relevance between the two diseases. We conducted the hospital-based case-control study to analyse the diabetes mellitus as a risk factor of the colorectal carcinoma, PC and PLC.In the survey of 864 colorectal carcinoma patients of our hospital , we found that the incidence rate for the patients suffering DM to have colorectal is increasing, but there is no obvious difference between sexes. With the course of DM elongating, the risk of colorectal carcinoma is increasing, however if the history of DM is more than 15 years, there is no relationbetween the two diseases. Meanwhile the incidence rate of local or distant metastasis for those with DM is higher than that of those without . In the survey of 147 PC patients of our hospital ,we discovered obvious relation between PC and DM, but there is no relation with DM and the place of tumor. With the course of DM elongating, the risk of PC is increasing, but there is no obvious difference between sexes.. Type 2 diabetes that the history of DM is less than 2 years might be the initial symptom of PC. Insulin resistance often happens at the beginning of the tumor, which is the cause of diabetes mellitus before the PC symptom , and DM is not considered as a risk factor of PC but as one of the results. Hence we believe that the newly appearing diabetes in patients, especial those without DM family history should be regarded as important clues for early PC diagnosing , and more attentions need to be paid to the possibility of PC. Mere clinical diagnose of DM is not enough. Regular examination isnecessary to the DM patients in order to have early discovery and diagnose of PC. In the survey of 848 PLC patients of our hospital, we discovered that DM could increase the incidence rate of PLC. With the course of DM elongating, the risk of PLC is increasing, but there is no obvious difference between sexes. After the individual study of other risk factors such as infection with HBV/HCV and alcohol consumption , we found that DM increased the risk of PLC whether or not having the presence of other risk factors such as HBV/HCV or alcoholic consumption. The possible mechanism of digestive system carcinoma induced by DM relates with the cooperations of multi-agents such as IGF-1, hyperinsulinism and insulin-resistance, impaired immunological function and weakening of immune supervision, chronic stimulation of long-term hyperglycemia, genetic factor, the long-term repetitive role of carcinogenic factor, the abnormality of metabolism microelement causing the disequilibrium of microelement, and so on. Conclusion: Among the DM patients, the incidence rate of digestive system carcinoma including colorectal carcinoma, PC and PLC is obviously increasing, With the course of DM elongating, the risks of colorectal carcinoma ,PC and PLC is increasing. Colorectal carcinoma patients with DM are inclined to...