Risk of Death in Colorectal Cancer Patients with Multi-morbidities of Metabolic Syndrome: A Retrospective Multicohort Analysis
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Purpose The prevalence of multi-morbidities with colorectal cancer (CRC) is known to be increasing. Particularly prognosis of CRC patients co-diagnosed with metabolic syndrome (MetSyn) was largely unknown. We aimed to examine the death risk of CRC patients according to the multiple MetSyn morbidities.Materials and Methods We identified CRC patients with MetSyn from the electronic medical records (EMR) systems in five independent hospitals during 2006-2011. Information on deaths was jointly retrieved from EMR, cause of death registry and chronic disease surveillance as well as study-specific questionnaire. Cox proportional hazards regression was used to calculate the overall and CRC-specific hazards ratios (HR) comparing MetSyn CRC cohort with reference CRC cohort.Results A total of 682 CRC patients in MetSyn CRC cohort were identified from 24 months before CRC diagnosis to 1 month after. During a median follow-up of 92 months, we totally observed 584 deaths from CRC, 245 being in MetSyn cohort and 339 in reference cohort. Overall, MetSyn CRC cohort had an elevated risk of CRC-specific mortality (HR, 1.49; 95% confidence interval [CI], 1.07 to 1.90) and overall mortality (HR, 1.43; 95% CI, 1.09 to 1.84) compared to reference cohort after multiple adjustment. Stratified analyses showed higher mortality risk among women (HR, 1.87; 95% CI, 1.04 to 2.27) and specific components of MetSyn. Notably, the number of MetSyn components was observed to be significantly related to CRC prognosis.Conclusion Our findings supported that multi-morbidities of MetSyn associated with elevated death risk after CRC. MetSyn should be considered as an integrated medical condition more than its components in CRC prognostic management.
Abstract
Purpose The prevalence of multi-morbidities with colorectal cancer (CRC) is known to be increasing. Particularly prognosis of CRC patients co-diagnosed with metabolic syndrome (MetSyn) was largely unknown. We aimed to examine the death risk of CRC patients according to the multiple MetSyn morbidities.Materials and Methods We identified CRC patients with MetSyn from the electronic medical records (EMR) systems in five independent hospitals during 2006-2011. Information on deaths was jointly retrieved from EMR, cause of death registry and chronic disease surveillance as well as study-specific questionnaire. Cox proportional hazards regression was used to calculate the overall and CRC-specific hazards ratios (HR) comparing MetSyn CRC cohort with reference CRC cohort.Results A total of 682 CRC patients in MetSyn CRC cohort were identified from 24 months before CRC diagnosis to 1 month after. During a median follow-up of 92 months, we totally observed 584 deaths from CRC, 245 being in MetSyn cohort and 339 in reference cohort. Overall, MetSyn CRC cohort had an elevated risk of CRC-specific mortality (HR, 1.49; 95% confidence interval [CI], 1.07 to 1.90) and overall mortality (HR, 1.43; 95% CI, 1.09 to 1.84) compared to reference cohort after multiple adjustment. Stratified analyses showed higher mortality risk among women (HR, 1.87; 95% CI, 1.04 to 2.27) and specific components of MetSyn. Notably, the number of MetSyn components was observed to be significantly related to CRC prognosis.Conclusion Our findings supported that multi-morbidities of MetSyn associated with elevated death risk after CRC. MetSyn should be considered as an integrated medical condition more than its components in CRC prognostic management.
참고문헌 (27)
- Grundy SM, "Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute", American Heart Association conference on scientific issues related to definition, 2004, pp.109, 433~438
- Pelucchi C, "Metabolic syndrome is associated with colorectal cancer in men", Eur J Cancer, 46, pp.1866~1872 (2010)
- Alberti KG, "The metabolic syndrome : a new worldwide definition", Lancet, 366, pp.1059~1062 (2005)
- Brenner H, "Colorectal cancer", Lancet, 383, pp.1490~1502 (2014)
- Esposito K, "Metabolic syndrome and risk of cancer : a systematic review and meta-analysis", Diabetes Care, 35, pp.2402~2411 (2012)
- Ishino K, "Metabolic syndrome : a novel high-risk state for colorectal cancer", Cancer Lett, 334, pp.56~61 (2013)
- Stocks T, "Blood pressure and risk of cancer incidence and mortality in the Metabolic Syndrome and Cancer Project", Hypertension, 59, pp.802~810 (2012)
- Ulmer H, "Metabolic risk factors and cervical cancer in the metabolic syndrome and cancer project(Me-Can)", Gynecol Oncol, 125, pp.330~335 (2012)
- Kabat GC, "A longitudinal study of the metabolic syndrome and risk of colorectal cancer in postmenopausal women", Eur J Cancer Prev, 21, pp.326~332 (2012)
- Esposito K, "Metabolic syndrome and cancer: holistic or reductionist?", Endocrine, 45, pp.362~364 (2014)
- Mendonca FM, "Metabolic syndrome and risk of cancer:which link?", Metabolism, 64, pp.182~189 (2015)
- Stocks T, "Metabolic factors and the risk of colorectal cancer in 580, 000 men and women in the metabolic syndrome and cancer project(Me-Can)", Cancer, 117, pp.2398~2407 (2011)
- Peeters PJ, "The risk of colorectal cancer in patients with type 2 diabetes : associations with treatment stage and obesity", Diabetes Care, 38, pp.495~502 (2015)
- Ferlay J, "Cancer incidence and mortality worldwide : sources, methods and major patterns in GLOBOCAN 2012", Int J Cancer, 136, pp.E359~86 (2015)
- Center MM, "Worldwide variations in colorectal cancer", CA Cancer J Clin, 59, pp.366~378 (2009)
- Bray F, "Global cancer statistics 2018 : GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries", CA Cancer J Clin, 68, pp.394~424 (2018)
- Saetang J, "Diets link metabolic syndrome and colorectal cancer development(Review)", Oncol Rep, 37, pp.1312~1320 (2017)
- Vargas T, "Genes associated with metabolic syndrome predict disease-free survival in stage II colorectal cancer patients : a novel link between metabolic dysregulation and colorectal cancer", Mol Oncol, 8, pp.1469~1481 (2014)
- Braun S, "The link between the metabolic syndrome and cancer", Int J Biol Sci, 7, pp.1003~1015 (2011)
- Russo A, "Metabolic syndrome and cancer risk", Eur J Cancer, 44, pp.293~297 (2008)
- Marrero JA, "Alcohol, tobacco and obesity are synergistic risk factors for hepatocellular carcinoma", J Hepatol, 42, pp.218~224 (2005)
- Xue F, "Diabetes, metabolic syndrome, and breast cancer : a review of the current evidence", Am J Clin Nutr, 86, pp.s823~35 (2007)
- Alberti KG, "Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation", Diabet Med, 15, pp.539~553 (1998)
- Norden A, "Letter: hypertension related to D.N.A. repair synthesis and carcinogen uptake", Lancet, 2, pp.1094~ (1975)
- Tie G, "Hypercholesterolemia increases colorectal cancer incidence by reducing production of NKT and gammadelta T cells from hematopoietic stem cells", Cancer Res, 77, pp.2351~2362 (2017)
- Cespedes Feliciano EM, "Metabolic dysfunction, obesity, and survival among patients with early-stage colorectal cancer", J Clin Oncol, 34, pp.3664~3671 (2016)
- Peng F, "Preoperative metabolic syndrome and prognosis after radical resection for colorectal cancer : The Fujian prospective investigation of cancer(FIESTA)study", Int J Cancer, 139, pp.2705~2713 (2016)