Association between diabetes and oncological outcomes in patients undergoing neoadjuvant chemo-radiotherapy for rectal cancer

Tina Fransgaard*, Jesper Hallas, Lau Caspar Thygesen, Ismail Gögenur

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Purpose: The aim of the study was to investigate, in a nationwide study, if diabetes and especially metformin exposure during neoadjuvant chemo-radiotherapy improves the oncological outcomes in patients with rectal cancer. Methods and materials: Patients undergoing neoadjuvant chemo-radiotherapy and curative intended resection for rectal cancer in Denmark between January 1, 2003 and July 1, 2015 were identified. Diabetes was defined as medically treated diabetes. Only patients who were either active users of antidiabetic medication at the beginning of the radiotherapy or never-users were included. Active users were matched with never-users 1:2 by propensity score. Subgroup analyses concerning metformin treatment were performed. The primary outcome of the study was disease-free survival and the secondary outcomes were recurrence free survival and all-cause mortality. Results: A total of 9799 patients were undergoing rectal cancer surgery with curative intend in the period. Of those, 2379 received neoadjuvant treatment up to one year preceding surgery. In total 459 patients were included in the study 154 patients with diabetes and 305 not diagnosed with diabetes. In the diabetes group, 53 were in active treatment with metformin. No statistical difference between the diabetes group and the non-diabetes group was shown with respect to disease free survival (HR 0.96, 95%CI 0.73–1.26, p = 0.77), recurrence-free survival (HR = 1.11, 95% CI 0.78–1.58, p = 0.56) or all-cause mortality (HR = 0.94, 95% CI 0.69–1.28, p = 0.69). Metformin treatment did not influence any of the outcomes. Conclusion: Our study does not support that diabetes or metformin use are associated with response to neoadjuvant chemo-radiotherapy in terms of disease-free survival, recurrence-free survival or all-cause mortality.

Original languageEnglish
JournalSurgical Oncology
Volume28
Pages (from-to)62-66
ISSN0960-7404
DOIs
Publication statusPublished - 1. Mar 2019

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Rectal Neoplasms
Disease-Free Survival
Propensity Score
Neoadjuvant Therapy
Denmark
Hypoglycemic Agents
Outcome Assessment (Health Care)

Keywords

  • Chemo-radiotherapy
  • Diabetes
  • Metformin
  • Rectal cancer

Cite this

@article{c0112e1645a54f849caeb40436198b96,
title = "Association between diabetes and oncological outcomes in patients undergoing neoadjuvant chemo-radiotherapy for rectal cancer",
abstract = "Purpose: The aim of the study was to investigate, in a nationwide study, if diabetes and especially metformin exposure during neoadjuvant chemo-radiotherapy improves the oncological outcomes in patients with rectal cancer. Methods and materials: Patients undergoing neoadjuvant chemo-radiotherapy and curative intended resection for rectal cancer in Denmark between January 1, 2003 and July 1, 2015 were identified. Diabetes was defined as medically treated diabetes. Only patients who were either active users of antidiabetic medication at the beginning of the radiotherapy or never-users were included. Active users were matched with never-users 1:2 by propensity score. Subgroup analyses concerning metformin treatment were performed. The primary outcome of the study was disease-free survival and the secondary outcomes were recurrence free survival and all-cause mortality. Results: A total of 9799 patients were undergoing rectal cancer surgery with curative intend in the period. Of those, 2379 received neoadjuvant treatment up to one year preceding surgery. In total 459 patients were included in the study 154 patients with diabetes and 305 not diagnosed with diabetes. In the diabetes group, 53 were in active treatment with metformin. No statistical difference between the diabetes group and the non-diabetes group was shown with respect to disease free survival (HR 0.96, 95{\%}CI 0.73–1.26, p = 0.77), recurrence-free survival (HR = 1.11, 95{\%} CI 0.78–1.58, p = 0.56) or all-cause mortality (HR = 0.94, 95{\%} CI 0.69–1.28, p = 0.69). Metformin treatment did not influence any of the outcomes. Conclusion: Our study does not support that diabetes or metformin use are associated with response to neoadjuvant chemo-radiotherapy in terms of disease-free survival, recurrence-free survival or all-cause mortality.",
keywords = "Chemo-radiotherapy, Diabetes, Metformin, Rectal cancer",
author = "Tina Fransgaard and Jesper Hallas and Thygesen, {Lau Caspar} and Ismail G{\"o}genur",
year = "2019",
month = "3",
day = "1",
doi = "10.1016/j.suronc.2018.11.007",
language = "English",
volume = "28",
pages = "62--66",
journal = "Surgical Oncology",
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publisher = "Elsevier",

}

Association between diabetes and oncological outcomes in patients undergoing neoadjuvant chemo-radiotherapy for rectal cancer. / Fransgaard, Tina; Hallas, Jesper; Thygesen, Lau Caspar; Gögenur, Ismail.

In: Surgical Oncology, Vol. 28, 01.03.2019, p. 62-66.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Association between diabetes and oncological outcomes in patients undergoing neoadjuvant chemo-radiotherapy for rectal cancer

AU - Fransgaard, Tina

AU - Hallas, Jesper

AU - Thygesen, Lau Caspar

AU - Gögenur, Ismail

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Purpose: The aim of the study was to investigate, in a nationwide study, if diabetes and especially metformin exposure during neoadjuvant chemo-radiotherapy improves the oncological outcomes in patients with rectal cancer. Methods and materials: Patients undergoing neoadjuvant chemo-radiotherapy and curative intended resection for rectal cancer in Denmark between January 1, 2003 and July 1, 2015 were identified. Diabetes was defined as medically treated diabetes. Only patients who were either active users of antidiabetic medication at the beginning of the radiotherapy or never-users were included. Active users were matched with never-users 1:2 by propensity score. Subgroup analyses concerning metformin treatment were performed. The primary outcome of the study was disease-free survival and the secondary outcomes were recurrence free survival and all-cause mortality. Results: A total of 9799 patients were undergoing rectal cancer surgery with curative intend in the period. Of those, 2379 received neoadjuvant treatment up to one year preceding surgery. In total 459 patients were included in the study 154 patients with diabetes and 305 not diagnosed with diabetes. In the diabetes group, 53 were in active treatment with metformin. No statistical difference between the diabetes group and the non-diabetes group was shown with respect to disease free survival (HR 0.96, 95%CI 0.73–1.26, p = 0.77), recurrence-free survival (HR = 1.11, 95% CI 0.78–1.58, p = 0.56) or all-cause mortality (HR = 0.94, 95% CI 0.69–1.28, p = 0.69). Metformin treatment did not influence any of the outcomes. Conclusion: Our study does not support that diabetes or metformin use are associated with response to neoadjuvant chemo-radiotherapy in terms of disease-free survival, recurrence-free survival or all-cause mortality.

AB - Purpose: The aim of the study was to investigate, in a nationwide study, if diabetes and especially metformin exposure during neoadjuvant chemo-radiotherapy improves the oncological outcomes in patients with rectal cancer. Methods and materials: Patients undergoing neoadjuvant chemo-radiotherapy and curative intended resection for rectal cancer in Denmark between January 1, 2003 and July 1, 2015 were identified. Diabetes was defined as medically treated diabetes. Only patients who were either active users of antidiabetic medication at the beginning of the radiotherapy or never-users were included. Active users were matched with never-users 1:2 by propensity score. Subgroup analyses concerning metformin treatment were performed. The primary outcome of the study was disease-free survival and the secondary outcomes were recurrence free survival and all-cause mortality. Results: A total of 9799 patients were undergoing rectal cancer surgery with curative intend in the period. Of those, 2379 received neoadjuvant treatment up to one year preceding surgery. In total 459 patients were included in the study 154 patients with diabetes and 305 not diagnosed with diabetes. In the diabetes group, 53 were in active treatment with metformin. No statistical difference between the diabetes group and the non-diabetes group was shown with respect to disease free survival (HR 0.96, 95%CI 0.73–1.26, p = 0.77), recurrence-free survival (HR = 1.11, 95% CI 0.78–1.58, p = 0.56) or all-cause mortality (HR = 0.94, 95% CI 0.69–1.28, p = 0.69). Metformin treatment did not influence any of the outcomes. Conclusion: Our study does not support that diabetes or metformin use are associated with response to neoadjuvant chemo-radiotherapy in terms of disease-free survival, recurrence-free survival or all-cause mortality.

KW - Chemo-radiotherapy

KW - Diabetes

KW - Metformin

KW - Rectal cancer

U2 - 10.1016/j.suronc.2018.11.007

DO - 10.1016/j.suronc.2018.11.007

M3 - Journal article

VL - 28

SP - 62

EP - 66

JO - Surgical Oncology

JF - Surgical Oncology

SN - 0960-7404

ER -