Research Article: Impact of long-term antihypertensive and antidiabetic medications on the prognosis of post-surgical colorectal cancer: the Fujian prospective investigation of cancer (FIESTA) study

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.

http://doi.org/10.18632/aging.101459

Abstract

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.

Partial Text

Colorectal cancer is a leading cause of cancer-related death worldwide [1]. In China, colorectal cancer ranked fifth among the national death rates for both genders, causing approximate 191,000 million deaths in 2015 [2]. Colorectal cancer is frequently diagnosed at advanced stages, and survival rates largely depend on cancer stages at diagnosis [3]. 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 [4]. 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 [5]. 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.

 

Source:

http://doi.org/10.18632/aging.101459

 

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