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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Poorly controlled type II diabetes mellitus significantly enhances postoperative chemoresistance in patients with stage III colon cancer
Ruo-Yu Guan, Jia-Wei Wu, Zi-Yun Yuan, Zhi-Yuan Liu, Zi-Zhu Liu, Zhi-Cong Xiao, Jing-Hui Li, Cheng-Zhi Huang, Jun-Jiang Wang, Xue-Qing Yao
Ruo-Yu Guan, Jia-Wei Wu, Jun-Jiang Wang, Xue-Qing Yao, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, Guangdong Province, China
Ruo-Yu Guan, Jia-Wei Wu, Zi-Yun Yuan, Zhi-Yuan Liu, Zi-Zhu Liu, Zhi-Cong Xiao, Jing-Hui Li, Cheng-Zhi Huang, Jun-Jiang Wang, Xue-Qing Yao, Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, Guangdong Province, China
Ruo-Yu Guan, Jia-Wei Wu, Zi-Yun Yuan, Zhi-Yuan Liu, Zi-Zhu Liu, Zhi-Cong Xiao, Jing-Hui Li, Xue-Qing Yao, Department of General Surgery, Guangdong Provincial People’s Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou 341000, Jiangxi Province, China
Zhi-Yuan Liu, Jun-Jiang Wang, Xue-Qing Yao, Shantou University Medical College, Shantou 515041, Guangdong Province, China
Zi-Zhu Liu, Jun-Jiang Wang, Xue-Qing Yao, School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong Province, China
Jing-Hui Li, Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
Co-first authors: Ruo-Yu Guan and Jia-Wei Wu.
Co-corresponding authors: Jun-Jiang Wang and Xue-Qing Yao.
Author contributions: Guan RY, Wu JW, and Yuan ZY contributed to the data acquisition; Guan RY and Wu JW contributed equally to this work as co-first authors; Liu ZY, Liu ZZ, and Xiao ZC participated in the quality control of data and algorithms; Guan RY, Liu ZY, and Li JH took part in the data analysis and interpretation; Guan RY and Liu ZZ contributed to the statistical analysis of this manuscript; Guan RY, Wu JW, Yuan ZY involved in the manuscript preparation; Guan RY and Yao XQ contributed to the manuscript review; Huang CZ, Wang JJ, and Yao XQ edited the manuscript; Yao XQ and Wang JJ contributed equally to this work as co-corresponding authors.
Supported by the Leading Innovation Specialist Support Program of Guangdong Province; the Science and Technology Planning Project of Ganzhou, No. 202101074816; and the National Natural Science Foundation of China, No. 82260501.
Institutional review board statement: The study received approval from the Clinical Research Ethics Committee of Guangdong Provincial People’s Hospital, No. S2024-629-01.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Xue-Qing Yao, MD, PhD, Professor, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Er Road, Guangzhou 510080, Guangdong Province, China.
syyaoxueqing@scut.edu.cn
Received: July 8, 2024
Revised: October 3, 2024
Accepted: November 25, 2024
Published online: January 21, 2025
Processing time: 164 Days and 17.3 Hours
BACKGROUND
Type II diabetes mellitus (T2DM) has been associated with increased risk of colon cancer (CC) and worse prognosis in patients with metastases. The effects of T2DM on postoperative chemoresistance rate (CRR) and long-term disease-free survival (DFS) and overall survival (OS) in patients with stage III CC who receive curative resection remain controversial.
AIM
To investigate whether T2DM or glycemic control is associated with worse postoperative survival outcomes in stage III CC.
METHODS
This retrospective cohort study included 278 patients aged 40-75 years who underwent surgery for stage III CC from 2018 to 2021. Based on preoperative T2DM history, the patients were categorized into non-DM (n = 160) and DM groups (n = 118). The latter was further divided into well-controlled (n = 73) and poorly controlled (n = 45) groups depending on the status of glycemic control. DFS, OS, and CRR were compared between the groups and Cox regression analysis was used to identify risk factors.
RESULTS
Patients in the DM and non-DM groups demonstrated similar DFS, OS, and CRR (DFS: 72.03% vs 78.75%, P = 0.178; OS: 81.36% vs 83.12%, P = 0.638; CRR: 14.41% vs 7.5%, P = 0.063). Poorly controlled DM was associated with a significantly worse prognosis and higher CRR than well-controlled DM (DFS: 62.22% vs 78.07%, P = 0.021; OS: 71.11% vs 87.67%, P = 0.011; CRR: 24.40% vs 8.22%, P = 0.015). High preoperative fasting plasma glucose [DFS: Hazard ratio (HR) = 2.684, P < 0.001; OS: HR = 2.105, P = 0.019; CRR: HR = 2.214, P = 0.005] and glycosylated hemoglobin levels (DFS: HR = 2.344, P = 0.006; OS: HR = 2.119, P = 0.021; CRR: HR = 2.449, P = 0.009) indicated significantly poor prognosis and high CRR, while T2DM history did not (DFS: HR = 1.178, P = 0.327; OS: HR = 0.933, P = 0.739; CRR: HR = 0.997, P = 0.581).
CONCLUSION
Increased preoperative fasting plasma glucose and glycosylated hemoglobin levels, but not T2DM history, were identified as risk factors associated with poor postoperative outcomes and high CRR in patients with stage III CC.
Core Tip: Type II diabetes mellitus (T2DM) has been consistently associated with high risk of carcinogenesis in gastrointestinal malignances. However, the relationship between T2DM and postoperative chemotherapy outcomes or long-term prognosis in patients with colon cancer remains unclear. This study emphasizes that preoperative poorly controlled hyperglycemia, but not T2DM history, is associated with enhanced chemoresistance and frustrating prognosis in patients who underwent surgery for stage III colon cancer. Our results also remind us of the importance of managing hyperglycemia in patients with T2DM, and that glycemic-related parameters such as fasting plasma glucose and glycosylated hemoglobin levels are potential predictive indicators for chemotherapy responses.
