Metabolic Characteristics Of Gastric Cancer And Colorectal Cancer With Diabetes And Their Impact On The Prognosis Of Cancer

Objective:Retrospectively examined the metabolic characteristics of gastric cancer(GC) and colorectal cancer(CRC) patients with diabetes mellitus(DM), and exploredthe relationship between metabolic characteristics of DM and tumor TNM stage,invasion, metastasis in patient with GC and CRC.Methods: First, Collected1830patients of GC and CRC in Department ofgastrointestinal Surgery， which were confirmed by gastroscopy biopsy and/orsurgical pathology diagnosis,1213male cases,617female cases, aged15-90yearsold. Including1057cases of GC,782male cases,275female cases, aged18-89yearsold,773cases of CRC,431male cases,342female cases, aged15-90years old.Thecases were tested fasting plasma glucose (FPG), albumin (ALB), total cholesterol(TCH), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low densitylipoprotein cholesterol(LDL-C), apolipoprotein-A(APO-A1), apolipoprotein-B(apo-B), free fatty acid (FFA), lipoprotein (a)(LP (a)), hemoglobin (HGB), fibrinogen(Fib), ECG, echocardiography. Then, we compared the metabolic characteristicsbetween with and without DM by t-test and Wilcoxon test. Chi-square test was usedto compare tumor TNM stage, invasion, lymph node metastasis, distantmetastasis,different differentiation, radical surgery rate, postoperative infection,postoperative complications in patients with and without DM. The role of Glucoseand lipid metabolism in TNM stage, invasion, lymph node metastasis, distantmetastasis was assessed by using spearman correlation and multiple regressionanalysis.Results:1.Detection rate of DM: Ratio of DM in GC was12.11%, male was11.89%,female was12.73%, there is no difference between men and women; ratio of DM inCRC was16.17%, Male was17.63%, female was14.33%, there is no differencebetween men and women; in CRC, ratio of DM in colon cancer was19.48%, male was22.50%, female was16.11%, there is no difference between men and women,ratio of DM in Rectum cancer was19.48%, Male was22.50%, female was16.11%,there is no difference between men and women. Colon cancer had higher proportionof DM than Rectum cancer (p <0.01). CRC had higher proportion of DM than gastriccancer (p <0.05). After standardized, ratio of DM in GC was7.58%, ratio of DM inCRC was10.15%, CRC had higher proportion of DM than general population of ourcountry (p <0.01), GC had lower proportion of DM than general population of ourcountry (p <0.01).2.General metabolism: Age,length of hospital stay, BMI, FPG, TG, APO-B ofGC patients with DM were higher than that without DM. HDL,APO-A1of GCpatients with DM were lower than that without DM. Age, BMI, FPG, TG, fib of CRCpatients with DM were higher than that without DM. ALB、HGB、TCH、HDL、APO-A1of CRC patients with DM were lower than that without DM.3.Cardiovascular disease: GC patients with DM had higher Detection ofhypertension, history of coronary artery disease, SBP, IVST, LVPWT, EF, LVM,PVE/e than that without DM. GC patients with DM had lower QT interval than thatwithout DM. CRC patients with DM had higher Detection of hypertension, history ofcoronary artery disease, SBP, LAD, IVST, LVPWT than that without DM.4. Tumor Pathological: In GC patients, difference of TNM stage, invasion,lymph node metastasis, distant metastasis and differentiation in with and without DMwas not statistically significant; difference of radical surgery postoperative infection,postoperative complications in with and without DM was also not statisticallysignificant. in CRC patients, the proportion of TNM stage Ⅳ in DM patients wasmore than patients without DM（p<0.01), the proportion of TNM stage ⅡA in DMpatients was less than patients without DM （p<0.01); the proportion of distantmetastasis in DM patients was more than patients without DM（p<0.01); difference ofinvasion, lymph node metastasis in with and without DM was not statisticallysignificant; difference of radical surgery postoperative infection, postoperativecomplications in with and without DM was also not statistically significant.5.Glucose metabolism and tumor: FPG in patients with advanced gastric higher than the early, multiple regression analysis showed that FPG was positivelycorrelated with the following: stage of gastric cancer (OR1.195,95%CI1.045-1.367),gastric cancer infiltration (OR1.176,95%CI1.014-1.365), gastric cancer lymph nodemetastasis (OR1.171,95CI1.017-1.349). Advanced colorectal cancer had higherproportion of DM than the early. Multivariate regression analysis showed that DMpositively correlated with the following: colorectal cancer stage (OR1.673,95%CI1.077-2.600), distant metastasis (OR1.996,95%CI1.192-3.345).6.Lipids and tumor: Multiple regression analysis showed that Lp (a) and thestage of DC was positively correlated (OR1.232,95%CI1.079-1.406), FFA and stageof GC was positively correlated (OR1.188,95%CI1.041-1.356), APO-A1wasnegatively correlated with the following: the stage of GC (OR0.770,95%CI0.673-0.880), infiltration (OR0.735,95%CI0.632-0.855), lymph node metastasis(OR0.853,95%CI0.742-0.981), distant metastasis (OR0.776,95%CI0.679-0.886).The multiple regression showed that FFA and distant metastasis of CRCwas positively correlated (OR1.327,95%CI1.086-1.620); Apo-A1was negativelycorrelated with following: CRC TNM stage (OR0.815,95%CI0.706-0.942),infiltration (OR0.748,95%CI0.611-0.915), lymph node metastasis(OR0.742,95%CI0.613-0.899), distant metastasis (OR0.802,95%CI0.654-0.984).Conclusion: GC and CRC patients with DM had more metabolic disorders than thatwithout DM; DM and its metabolic characteristics were positively correlated withstage, invasion and metastasis of GC and CRC.