J Gynecol Oncol.  2016 May;27(3):e28. 10.3802/jgo.2016.27.e28.

Impact of diabetes mellitus on oncological outcomes after radical hysterectomy for early stage cervical cancer

• Jiamset I
• Hanprasertpong J

• KMID: 2363322
• DOI: http://doi.org/10.3802/jgo.2016.27.e28

Abstract

OBJECTIVE
To evaluate the relationship between type 2 diabetes mellitus (DM) and oncological outcomes in early stage cervical cancer patients who underwent radical surgical resection.
METHODS
Patients with early stage cervical cancer diagnosed between 2001 and 2014 were retrospectively enrolled. We assessed the outcomes of 402 non-DM and 42 DM patients with cervical cancer. We tested the prognostic value of DM via Cox proportional hazard modeling.
RESULTS
Patients with DM were more likely to be older and overweight. In the DM group, 20 and 22 patients were and were not taking metformin, respectively. The 5-year recurrence-free survival (RFS) and 5-year overall survival (OS) rate for the whole study population were 88.49% and 96.34%, respectively. In the DM group, there was no evidence that metformin affected the RFS (p=0.553) or the OS (p=0.429). In multivariate analysis, age (p=0.007), histology (p=0.006), and deep stromal invasion (p=0.007) were independent adverse prognostic factors for RFS. There was a borderline significant association of increased RFS with DM (p=0.051). However, a time-varying-effect Cox model revealed that the DM was associated with a worse RFS (hazard ratio, 11.15; 95% CI, 2.00 to 62.08, p=0.022) after 5 years. DM (p=0.008), age (p=0.009), and node status (p=0.001) were the only 3 independent prognostic factors for OS.
CONCLUSION
Early stage cervical cancer patients with type 2 DM have a poorer oncological outcome than patients without DM.

Keyword

Diabetes Mellitus; Hysterectomy; Metformin; Prognosis; Uterine Cervical Neoplasms

MeSH Terms

Adult
Age Factors
Diabetes Mellitus, Type 2/*complications/drug therapy
Female
Humans
Hypoglycemic Agents/therapeutic use
*Hysterectomy
Metformin/therapeutic use
Middle Aged
Prognosis
Proportional Hazards Models
Retrospective Studies
Survival Analysis
Uterine Cervical Neoplasms/*complications/diagnosis/surgery
Hypoglycemic Agents
Metformin