Impact of Diabetes Mellitus on the Prognosis of Patients with Oral Squamous Cell Carcinoma: A Retrospective Cohort Study
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Diabetes mellitus (DM) is a prevalent chronic metabolic disease reported to affect the treatment outcomes of malignancies. This study explores the impact of diabetes on the prognosis of oral squamous cell carcinoma (OSCC).
Materials and Methods
Clinicopathological characteristics and survival in terms of overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) of patients with OSCC who underwent surgical intervention at the Taipei Veterans General Hospital between 2002 and 2005 were stratified by diabetic status and compared.
Patients with DM tend to have a lower OS, RFS, and CSS compared with nondiabetics (adjusted hazard ratio [HR] = 2.22, 2.42, and 2.16, respectively) even in less aggressive tumor stages (stage I and II). In advanced tumors, diabetic patients who were not prescribed adjuvant therapy had a significantly higher recurrence rate than nondiabetic patients (HR = 2.66). However, there was no significant difference in treatment outcome in patients with locally advanced tumors amenable to receive adjuvant therapy, even with the delayed initiation of adjuvant therapy in the DM group (49.1 ± 22.3 days vs. 40.0 ± 16.6 days, P = .04). DM was also associated with a higher frequency of perineural invasion (adjusted odds ratio [OR] = 2.53).
DM status could be a prognostic factor for OSCC, particularly for its effect in the survival and perineural invasion. Although diabetes-associated comorbidities may impair decision making toward less aggressive therapeutic modality, adjuvant treatment may be essential for DM patients to improve their survival.
KeywordsOverall Survival Oral Squamous Cell Carcinoma Impaired Fasting Glucose Perineural Invasion Oral Squamous Cell Carcinoma
We thank Dr. Harn-Shen Chen from Department of Endocrinology & Metabolism, Taipei Veterans General Hospital for his critical comment in diabetes stratification in the present study. This work was supported by grant V98A-031 and V98A-035 of the Taipei Veterans General Hospital, by grant NSC96-2314-B- 075-063-MY3 of the National Science Council, Executive Yuan, Taiwan (ROC). The authors declare no conflicts of interest.
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