By all accounts, a combination of colon cancer, diabetes and high blood pressure can be a recipe for medical disaster. Now, a new study led by a surgical oncologist and researcher at Temple University School of Medicine and Fox Chase Cancer Center has shown just how deadly this mix can be. In a retrospective analysis of more than 36,000 patients with colon cancer, investigators showed that those with early stage disease and diabetes or high blood pressure – two components of metabolic syndrome – have a greater risk for the cancer returning after treatment and of dying compared to patients with colon cancer who do not have either condition.
"Although metabolic syndrome has been linked to colon cancer, the third leading cause of cancer death in the U.S., previous work looking at its effect on mortality has not adequately accounted for cancer stage or treatment," said senior author Nestor Esnaola, MD, MPH, MBA, Chief of the Division of Surgical Oncology, Professor of Vice-Chair of Clinical and Academic Affairs in the Department of Surgery at Temple University School of Medicine. "Our results suggest that patients with early stage colon cancer who also have diabetes or hypertension may need to be followed more closely for recurrence and could potentially benefit from broader use of adjuvant chemotherapy." Dr. Esnaola and his team reported their findings December 20, 2012 in an early online publication in the journal CANCER.
Metabolic syndrome is a cluster of conditions that affects one in five American adults and which can include diabetes, obesity, high blood pressure, low levels of good cholesterol and high amounts of lipids in the blood.
To better understand the effect of metabolic syndrome on colon cancer outcomes, Dr. Esnaola and his team linked data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program, a large population-based database, to Medicare data from 1998 to 2006 on 36,079 patients with colon cancer, including 7,024 patients (19.5 percent) who were identified as having metabolic syndrome. They analyzed the effect of metabolic syndrome and its components on colon cancer recurrence and overall survival, controlling for various sociodemographic factors, tumor factors, other medical conditions and cancer treatment received.
"Metabolic syndrome as a whole had no apparent effect on colon cancer recurrence or survival," said Dr. Esnaola, who is also an attending surgeon at Fox Chase Cancer Center. "When we teased out and analyzed the effect of each of its components, however, the data told a different story."
The researchers found that among patients with early stage disease, patients with diabetes or high blood pressure had a significantly greater risk of cancer recurrence rate and death after treatment. For example, 47.7 percent of patients who did not have diabetes were still alive five years after diagnosis compared to only 41.3 percent of patients with diabetes. When the researchers looked more closely, they also found that cancer recurrence rates at five years were approximately 8 percent higher in patients with diabetes or hypertension.
In contrast, the analysis showed that patients with abnormally high levels of lipids in the blood had a lower risk of recurrence and death from colon cancer. Overall, 39 percent of patients with normal lipid levels were still alive after five years, compared to 52.7 percent of patients with abnormal levels. Cancer recurrence rates were approximately 11 percentage points lower in patients with abnormal lipid levels.
"Although we did not have data on medication for these patients, we suspect that the higher survival and lower recurrence rates observed in patients with high lipid levels in our study group were likely due to the protective effects of statins," Dr. Esnaola said. Statins are drugs that are widely used to lower cholesterol and lipid levels and have been shown to lower the risk of developing colon cancer in people.
"To our knowledge, this is the largest study to date controlling for cancer stage and treatment that has analyzed the effect of metabolic syndrome and its components on colon cancer recurrence and survival," said Dr. Esnaola. "The adverse effects of diabetes and hypertension in early stage patients and apparent protective effect of high blood lipids observed in our cohort suggest that when it comes to metabolic syndrome and cancer outcomes, the devil is in the details."
Dr. Esnaola currently is investigating the effect of metabolic syndrome and its components on other cancer types, and plans to confirm these results in a larger set of data that contains information on cancer stage, treatment and medication. "In the interim, our results underscore the need for clinical trials to define the true benefits of (the diabetes drug) metformin and statins in patients with early stage colon cancer," he said.
Temple University Health System: http://www.templehealth.org/
This press release was posted to serve as a topic for discussion. Please comment below. We try our best to only post press releases that are associated with peer reviewed scientific literature. Critical discussions of the research are appreciated. If you need help finding a link to the original article, please contact us on twitter or via e-mail.
The complicated science behind picky eating is giving experts plenty of food for thought
The compound kills disease-causing parasites by popping them like water balloons
The U.S. had planned to build 17 treatment units across Liberia, one in each county's major town. Now that more cases are appearing in remote areas, the Army may need to rethink its strategy.
A woman is thought to be spreading Ebola in a remote village. So health workers spend four hours trekking through the bush to track her down. By the time they make it, it's too late.
Doctors have used perfect replicas of childrens' hearts to uncover and repair hidden defects
An experiment testing people’s altruism in the face of electric shocks is clear on one thing: we are drawn to these little blasts
Researchers gear up tests in West Africa to see whether blood from Ebola survivors can help people who are sick with the disease. This is part of a broader effort to test therapies in West Africa.
The virus's foray into Europe coincides with peak production of Christmas turkeys, the poultry species most vulnerable to bird flu
A novel kind of nanoparticle could lead to more effective cancer treatments.Patients and doctors often don’t know if surgery to remove cancerous tissue was successful until scans are performed months later. A new kind of nanoparticle could show patients if they’re in the clear much earlier.
One challenge in evaluating the effectiveness of different medical procedures, is that patients behave differently after different procedures. Is this true for patients getting heart surgery?