Cancer Res Treat.  2021 Jul;53(3):714-723. 10.4143/crt.2020.481.

Risk of Death in Colorectal Cancer Patients with Multi-morbidities of Metabolic Syndrome: A Retrospective Multicohort Analysis

  • 1Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
  • 2Department of Oncology and Hematology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
  • 3Department of Orthopaedics, Orthopaedic Institute, the First Affiliated Hospital, Soochow University, Suzhou, China
  • 4Department of General Surgery, Harrison International Peace Hospital, Hengshui, China
  • 5Medical Research Centre, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
  • 6Department of Radiation Oncology, Sichuan Cancer Hospital/Institute, University of Electronic Science and Technology of China, Chengdu, China
  • 7Centre of Systems Medicine, Chinese Academy of Medical Sciences, Beijing, China
  • 8Suzhou Institute of Systems Medicine, Suzhou, China
  • 9Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China


The prevalence of multi-morbidities with colorectal cancer (CRC) is known to be increasing. Particularly prognosis of CRC patients co-diagnosed with metabolic syndrome (MetSyn) was largely unknown. We aimed to examine the death risk of CRC patients according to the multiple MetSyn morbidities.
Materials and Methods
We identified CRC patients with MetSyn from the electronic medical records (EMR) systems in five independent hospitals during 2006-2011. Information on deaths was jointly retrieved from EMR, cause of death registry and chronic disease surveillance as well as study-specific questionnaire. Cox proportional hazards regression was used to calculate the overall and CRC-specific hazards ratios (HR) comparing MetSyn CRC cohort with reference CRC cohort.
A total of 682 CRC patients in MetSyn CRC cohort were identified from 24 months before CRC diagnosis to 1 month after. During a median follow-up of 92 months, we totally observed 584 deaths from CRC, 245 being in MetSyn cohort and 339 in reference cohort. Overall, MetSyn CRC cohort had an elevated risk of CRC-specific mortality (HR, 1.49; 95% confidence interval [CI], 1.07 to 1.90) and overall mortality (HR, 1.43; 95% CI, 1.09 to 1.84) compared to reference cohort after multiple adjustment. Stratified analyses showed higher mortality risk among women (HR, 1.87; 95% CI, 1.04 to 2.27) and specific components of MetSyn. Notably, the number of MetSyn components was observed to be significantly related to CRC prognosis.
Our findings supported that multi-morbidities of MetSyn associated with elevated death risk after CRC. MetSyn should be considered as an integrated medical condition more than its components in CRC prognostic management.


Colorectal neoplasms; Metabolic syndrome; Multi-morbidities; Risk of death; Prognosis
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