| Objective:The clinical characteristics of colon cancer patients with type 2 diabetes mellitus(T2DM)are analyzed in the study,in which I explore the effects of T2DM and blood glucose levels on the prognosis of stageⅡ–Ⅲcolon cancer from the perspective of overall survival(OS),so as to provide clinical reference for the diagnosis and treatment of colon cancer patients with T2DM.Methods:A total of 262 patients who received radical surgery for colon cancer in the Department of Surgery,Affiliated Hospital of Qingdao University from January 2015 to January 2016 and met the conditions of the study were selected.Among them,80 cases of colon cancer patients with T2DM were in the observation group and 182 cases of colon cancer patients with no history of T2DM were in the control group.Then,patients’basic data,postoperative pathology,their courses of T2DM,initial clinical symptoms,preoperative laboratory indexes,short-term postoperative complications,postoperative treatments and toxic reactions were collected and recorded.The OS of patients was followed up through a combination of telephone follow-up and access to the hospital’s medical record system.SPSS 22.0 software was applied to analyze the differences in clinical pathological characteristics between the two groups and construct a receiver operating characteristic curve(ROC)to certify the optimal cutoff value of hemoglobin A1c(Hb A1c).Kaplan-Meier method was used to draw the survival curve,Log-rank method was used for univariate analysis and Cox regression model was used for multivariate analysis.The P<0.05 was considered significant.Results:1.There were statistical differences in age of onset and BMI between the two groups(P=0.001 and 0.026),and the proportion of patients with age of onset≥60 years and BMI≥24kg/m~2in the group with T2DM was significantly higher than that in the control group.2.The tumors located in the right-sided colon was more likely to occur in the group with T2DM,and the local invasion depth was deeper.The lymph node metastasis rate in the group with T2DM was higher than that in the control group,and there were statistical differences(P=0.048,0.039,0.034).3.Forty-three patients(53.75%)had T2DM with a course of disease no more than five years,15 patients(18.75%)had it from 5 to 10 years,and 22 patients(27.50%)had it from more than 10 years.Colon cancer commonly occurred in patients with T2DM within five years of course.4.The incidence rate of constipation as the first clinical symptom in patients combined with T2DM was 11.25%,which was higher than that of constipation in the control group(1.10%),and the difference was statistically significant(P=0.001).5.Laboratory tests showed that the preoperative levels of fasting blood glucose,white blood cells,triglycerides and CEA in patients with T2DM were higher than those in the control group,while the levels of high-density lipoprotein and AST were lower than those in the control group.The differences were statistically significant(P<0.05).6.The incidence rate of postoperative incision infection and pulmonary infection in patients with T2DM were 18.75%and 17.50%,respectively,which were higher than those of the control group(9.34%and 8.79%),with statistically significant differences(P=0.032 and 0.041).7.The proportions of patients receiving postoperative adjuvant chemotherapy in the two groups were 53.75%(T2DM group)and 54.40%(non-T2DM group),and the difference was not statistically significant(P=0.991).The incidence of renal impairment(13.95%)and capecitabine-related hand-foot syndrome(20.00%)after chemotherapy in patients with T2DM were significantly higher than those in the control group(0.00%and3.70%),with statistically significant differences(P=0.001 and 0.016).8.The optimal threshold for glycemic control in patients with colon cancer with T2DM was Hb A1c=7.80%(sensitivity 57.69%,specificity 79.63%).The 5-year survival rate of patients with poor glycemic control(Hb A1C>7.80%)was only 42.31%,which was significantly lower than the 5-year survival rate(79.63%)of patients with fair glycemic control(Hb A1c≤7.80%),and the difference was statistically significant(P<0.001).9.The 5-year survival rate of patients with T2DM was 67.50%,while that of patients without T2DM was 79.67%,and the difference was not statistically significant(P=0.064).The history of T2DM was not a factor affecting the prognosis of colon cancer.Univariate analysis illustrated that BMI,clinical stage,white blood cells and triglycerides were closely related to OS of colon cancer(P<0.05),while Cox multivariate analysis displayed that BMI,clinical stage and white blood cells were the independent factors affecting OS of colon cancer(P=0.041,0.002 and 0.001).Conclusion:Patients that had colon cancer with T2DM were inclined to onset at an elder age with larger BMI,and tended to occur in the early stage of T2DM course,with later pathological staging.The first clinical manifestation of constipation was more common.Postoperative pulmonary infection and incision infection were more likely to occur,as well as renal impairment and capecitabine-related hand-foot syndrome after chemotherapy.The history of T2DM could affect levels of white blood cells,triglycerides,CEA,high-density lipoprotein,and AST in patients with colon cancer at the time of onset.The prognosis of patients with acceptable glycemic control was better than that of patients with T2DM colon cancer who had poor glycemic control.The target value of glycemic control level should be Hb A1c=7.80%.The history of T2DM was not a factor influencing the prognosis of colon cancer,while BMI,clinical stage and white blood cells were independent factors influencing the prognosis of colon cancer. |
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