Date Published: May 24, 2018
Publisher: Impact Journals
Author(s): Feng Peng, Dan Hu, Xiandong Lin, Binying Liang, Ying Chen, Hejun Zhang, Yan Xia, Jinxiu Lin, Xiongwei Zheng, Wenquan Niu.
Hypertension and diabetes mellitus are common comorbidities of colorectal cancer. We designed a prospective cohort study aiming to investigate the impact of long-term antihypertensive and antidiabetic medications on colorectal cancer-specific survival and recurrence among 713 post-surgical patients. All participants received radical resection for colorectal cancer during 2000-08, and they were followed up until July 2017. Colorectal cancer patients without hypertension had better survival than those with hypertension (median survival time [MST]: 190.3 months versus 99.0 months, p <0.001). The impact of antidiabetic medications on prolonging colorectal cancer survival was statistically significant, that is, patients receiving antidiabetic medications had longer survival time than untreated diabetic patients (MST: 135.8 months versus 80.2 months, p: 0.007), whereas the prognosis was greatly improved in colorectal cancer patients without diabetes mellitus (p <0.001). Medical treatment for hypertension and diabetes mellitus was associated with 28% (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.47-1.10; p: 0.131) and 57% (HR: 0.43; 95% CI: 0.22-0.82; p: 0.010) reduced risk of dying from colorectal cancer relative to those without medications, respectively. Our data indicate that long-term antidiabetic medications can significantly prolong the survival and improve the prognosis of post-surgical colorectal cancer.
Colorectal cancer is a leading cause of cancer-related death worldwide . In China, colorectal cancer ranked fifth among the national death rates for both genders, causing approximate 191,000 million deaths in 2015 . Colorectal cancer is frequently diagnosed at advanced stages, and survival rates largely depend on cancer stages at diagnosis . According to the staging system defined by the American Joint Committee on Cancer (AJCC) 6th edition system, the 5-year survival rate of colorectal cancer was 93.2% for stage I, 84.7% for stage IIa, 72.2% for stage IIb, 83.4% for stage IIIa, 64.1% for stage IIIb, 44.3% for stage IIIc and 8.1% for stage IV . Because advanced patients often have poor prognosis, it is important to develop targeted prevention and early intervention strategies in control of colorectal cancer. From a clinical standpoint, surgery has long been established as the mainstay treatment for colorectal cancer . The fact of matter, however, is that even after the surgery, colorectal cancer prognosis still is far from satisfying [6,7]. Consequently, current research interest has shifted to devise rational and effective strategies for improving the long-term prognosis of colorectal cancer.
As an extension of our previous FIESTA study [14,19-26], we investigated the impact of long-term antihypertensive and antidiabetic medications on colorectal cancer-specific survival and recurrence in post-surgical patients. Noteworthily, our data indicate that long-term antidiabetic medications can significantly prolong the survival and improve the prognosis of post-surgical colorectal cancer, whereas the anticancer impact of long-term antihypertensive medications was not obvious. Our findings highlight the importance of enhanced screening and targeted management of diabetes mellitus in colorectal cancer patients, especially after radical resection.