Prognostic Impact of Type 2 Diabetes in Metastatic Colorectal Cancer

Mafalda Miranda Baleiras; Tiago Dias Domingues; Eduardo Severino; Carolina Vasques; Maria Teresa Neves; André Ferreira; Leonor Vasconcelos de Matos; Filipa Ferreira; Helena Miranda; Ana Martins

doi:10.7759/cureus.33916

Prognostic Impact of Type 2 Diabetes in Metastatic Colorectal Cancer

Cureus. 2023 Jan 18;15(1):e33916. doi: 10.7759/cureus.33916. eCollection 2023 Jan.

Affiliations

¹ Department of Medical Oncology, Centro Hospitalar de Lisboa Ocidental, Lisbon, PRT.
² Centre of Statistics and its Applications (CEAUL), Faculdade de Ciências da Universidade de Lisboa, Lisbon, PRT.
³ Breast Unit, Centro Clínico Champalimaud, Lisboa, PRT.

Abstract

Background Diabetes mellitus (DM) is a prognostic factor for some malignancies, but its clinical implications in metastatic colorectal cancer (mCRC) patients are less clear. Therefore, we conducted a retrospective study to evaluate the impact of pre-existing type 2 diabetes mellitus (T2DM) on the survival outcomes of patients with newly diagnosed mCRC. Methodology We retrospectively included patients with newly diagnosed mCRC between January 2017 and June 2021 and with pre-existing T2DM. Data on the characteristics of patients, clinicopathological features, and drug exposure were collected from the electronic medical records. The primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival (PFS) and treatment-related adverse events (TRAEs). Results Among 187 mCRC patients, 54 (28.8%) had T2DM. The median follow-up was 25 months. We observed 150 OS events and 168 PFS events. Diabetes significantly and negatively impacted PFS and OS. The median for PFS (mPFS) was eight and 16 months for T2DM and no T2DM patients, respectively (p < 0.0001; log-rank test). The median overall survival (mOS) was 15 and 29 months for T2DM and no T2DM patients, respectively (p < 0.0001; log-rank test). Patients with diabetes were more often overweight or obese (59.3% vs. 24.8%; p < 0.01) and had a poorer performance status (53.7% vs. 21.1% with Eastern Cooperative Oncology Group Performance Status 1; p < 0.01). Additionally, T2DM patients had more high-risk pathological features, including G3 grading tumors (27.7% vs. 12.0%; p = 0.01), lymph node involvement (p < 0.01), BRAF-mutated (35.1% vs. 6.8%; p < 0.01), and right-sided CRC (63.0% vs. 30.1%; p < 0.01). We found no statistically significant differences in TRAEs. Nevertheless, a significantly higher rate of grade 2-4 peripheral neuropathy (22.2% vs. 5.3%; p < 0.01) was reported in T2DM patients. Conclusions T2DM is a negative prognostic factor for survival in mCRC. The paper provides empirical evidence in favor of the joint control of both pathologies. Further research is needed to establish the robustness of our results.

Keywords: diabetes mellitus; hyperinsulinemia; insulin resistance; metastatic colorectal cancer; metformin; prognosis.