Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2010

01-08-2010 | Head and Neck Oncology

Impact of Diabetes Mellitus on the Prognosis of Patients with Oral Squamous Cell Carcinoma: A Retrospective Cohort Study

Authors: Cheng-Hsien Wu, DDS, Tzu-Ying Wu, DDS, Chia-Chen Li, DDS, Man-Tin Lui, DDS, Kuo-Wei Chang, DDS, PHD, Shou-Yen Kao, DDS, DMSc

Published in: Annals of Surgical Oncology | Issue 8/2010

Login to get access

Abstract

Background

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.

Results

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).

Conclusion

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.
Appendix
Available only for authorised users
Literature
1.
Moore SR, Johnson NW, Pierce AM, Wilson DF. The epidemiology of mouth cancer: a review of global incidence. Oral Dis. 2000;6:65–74.PubMed
2.
Carvalho AL, Magrin J, Kowalski LP. Sites of recurrence in oral and oropharyngeal cancers according to the treatment approach. Oral Dis. 2003;9:112–8.CrossRefPubMed
3.
Carvalho AL, Singh B, Spiro RH, Kowalski LP, Shah JP. Cancer of the oral cavity: a comparison between institutions in a developing and a developed nation. Head Neck. 2004;26:31–8.CrossRefPubMed
4.
Agra IM, Carvalho AL, Ulbrich FS, de Campos OD, Martins EP, Magrin J, et al. Prognostic factors in salvage surgery for recurrent oral and oropharyngeal cancer. Head Neck. 2006;28:107–13.CrossRefPubMed
5.
Howe HL, Wu X, Ries LA, Cokkinides V, Ahmed F, Jemal A, et al. Annual report to the nation on the status of cancer, 1975–2003, featuring cancer among U.S. Hispanic/Latino populations. Cancer. 2006;107:1711–42.CrossRefPubMed
6.
Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer. 2001;94:153–6.CrossRefPubMed
7.
Shieh TM, Lin SC, Liu CJ, Chang SS, Ku TH, Chang KW. Association of expression aberrances and genetic polymorphisms of lysyl oxidase with areca-associated oral tumorigenesis. Clin Cancer Res. 2007;13:4378–85.CrossRefPubMed
8.
Wu CH, Tu HF, Gong NR, Chen YW, Liu CJ, Kao SY. The Val allele of HER-2 codon 655 predicts the progression of oral squamous cell carcinoma. Oral Oncol. 2009;45:579–83.CrossRefPubMed
9.
Genden EM, Ferlito A, Bradley PJ, Rinaldo A, Scully C. Neck disease and distant metastases. Oral Oncol. 2003;39:207–12.CrossRefPubMed
10.
Hu FB, Manson JE, Liu S, Hunter D, Colditz GA, Michels KB, et al. Prospective study of adult onset diabetes mellitus (type 2) and risk of colorectal cancer in women. J Natl Cancer Inst. 1999;91:542–7.CrossRefPubMed
11.
Nilsen TI, Vatten LJ. Prospective study of colorectal cancer risk and physical activity, diabetes, blood glucose and BMI: exploring the hyperinsulinaemia hypothesis. Br J Cancer. 2001;84:417–22.CrossRefPubMed
12.
Will JC, Galuska DA, Vinicor F, Calle EE. Colorectal cancer: another complication of diabetes mellitus? Am J Epidemiol. 1998;147:816–25.PubMed
13.
Michels KB, Solomon CG, Hu FB, Rosner BA, Hankinson SE, Colditz GA, et al. Type 2 diabetes and subsequent incidence of breast cancer in the Nurses’ Health Study. Diabetes Care. 2003;26:1752–8.CrossRefPubMed
14.
Ujpal M, Matos O, Bibok G, Somogyi A, Szabó G, Suba Z. Diabetes and oral tumors in Hungary: epidemiological correlations. Diabetes Care. 2004;27:770–4.CrossRefPubMed
15.
Ujpal M, Matos O, Bibok G, Szabo G. Incidence of diabetes mellitus in patients with malignant tumors of the oral cavity. Orv Hetil. 2002;143:2731–3.PubMed
16.
Verlato G, Zoppini G, Bonora E, Muggeo M. Mortality from site-specific malignancies in type 2 diabetic patients from Verona. Diabetes Care. 2003;26:1047–51.CrossRefPubMed
17.
Barone BB, Yeh HC, Snyder CF, Peairs KS, Stein KB, Derr RL, et al. Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis. JAMA. 2008;300:2754–64.CrossRefPubMed
18.
Parkin DM, Whelan SL, Ferlay J, Teppo L, Thomas DB. Cancer Incidence in Five Continents. Vol. VIII: IARC Scientific Publication No. 155; 2003.
19.
Goutzanis L, Vairaktaris E, Yapijakis C, Kavantzas N, Nkenke E, Derka S, et al. Diabetes may increase risk for oral cancer through the insulin receptor substrate-1 and focal adhesion kinase pathway. Oral Oncol. 2007;43:165–73.CrossRefPubMed
20.
Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. Geneva: World Health Organization; 2006.
21.
Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M, eds. American Joint Committee on Cancer: AJCC cancer staging manual. 6th ed. New York: Springer; 2002.
22.
Brandwein-Gensler M, Teixeira MS, Lewis CM, Lee B, Rolnitzky L, Hille JJ, et al. Oral squamous cell carcinoma: histologic risk assessment, but not margin status, is strongly predictive of local disease-free and overall survival. Am J Surg Pathol. 2005;29:167–78.CrossRefPubMed
23.
Woolgar JA. Histopathological prognosticators in oral and oropharyngeal squamous cell carcinoma. Oral Oncol. 2006;42:229–39.CrossRefPubMed
24.
Mulder GD. Wound Care Communications Network. Clinician’s Pocket Guide to Chronic Wound Repair. PA: Springhouse; 1998. p. 58–67.
25.
Kramer S, Gelber RD, Snow JB, Marcial VA, Lowry LD, Davis LW, et al. Combined radiation therapy and surgery in the management of advanced head and neck cancer: final report of study 73-03 of the Radiation Therapy Oncology Group. Head Neck Surg. 1987;10:19–30.CrossRefPubMed
26.
Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004;350:1945–52.CrossRefPubMed
27.
Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004;350:1937–44.CrossRefPubMed
28.
2002 Survey on the Prevalence of Hypertension, Hyperglycemia and Hyperlipidemia in Taiwan. Bureau of Health Promotion DoH, Executive Yuan, R.O.C. (Taiwan), ed., 2003.
29.
Larsson SC, Mantzoros CS, Wolk A. Diabetes mellitus and risk of breast cancer: a meta-analysis. Int J Cancer. 2007;121:856–62.CrossRefPubMed
30.
Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst. 2005;97:1679–87.CrossRefPubMed
31.
Friberg E, Orsini N, Mantzoros CS, Wolk A. Diabetes mellitus and risk of endometrial cancer: a meta-analysis. Diabetologia. 2007;50:1365–74.CrossRefPubMed
32.
El-Serag HB, Hampel H, Javadi F. The association between diabetes and hepatocellular carcinoma: a systematic review of epidemiologic evidence. Clin Gastroenterol Hepatol. 2006;4:369–80.CrossRefPubMed
33.
Huxley R, Ansary-Moghaddam A, Berrington de Gonzalez A, Barzi F, Woodward M. Type-II diabetes and pancreatic cancer: a meta-analysis of 36 studies. Br J Cancer. 2005;92:2076–83.CrossRefPubMed
34.
Ko C, Chaudhry S. The need for a multidisciplinary approach to cancer care. J Surg Res. 2002;105:53–7.CrossRefPubMed
35.
Ko YC, Chiang TA, Chang SJ, Hsieh SF. Prevalence of betel quid chewing habit in Taiwan and related sociodemographic factors. J Oral Pathol Med. 1992;21:261–4.CrossRefPubMed
36.
Ko YC, Huang YL, Lee CH, Chen MJ, Lin LM, Tsai CC, et al. Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan. J Oral Pathol Med. 1995;24:450–3.CrossRefPubMed
37.
Boucher BJ, Ewen SW, Stowers JM. Betel nut (Areca catechu) consumption and the induction of glucose intolerance in adult CD1 mice and in their F1 and F2 offspring. Diabetologia. 1994;37:49–55.CrossRefPubMed
38.
Boucher BJ, Mannan N. Metabolic effects of the consumption of Areca catechu. Addict Biol. 2002;7:103–10.CrossRefPubMed
39.
Tung TH, Chiu YH, Chen LS, Wu HM, Boucher BJ, Chen TH. A population-based study of the association between areca nut chewing and type 2 diabetes mellitus in men (Keelung Community-based Integrated Screening programme No. 2). Diabetologia. 2004;47:1776–81.CrossRefPubMed
40.
Wei M, Gaskill SP, Haffner SM, Stern MP. Effects of diabetes and level of glycemia on all-cause and cardiovascular mortality. The San Antonio Heart Study. Diabetes Care. 1998;21:1167–72.CrossRefPubMed
41.
Gu K, Cowie CC, Harris MI. Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971–1993. Diabetes Care. 1998;21:1138–45.CrossRefPubMed
42.
Saydah SH, Eberhardt MS, Loria CM, Brancati FL. Age and the burden of death attributable to diabetes in the United States. Am J Epidemiol. 2002;156:714–9.CrossRefPubMed
43.
Peters LJ, Goepfert H, Ang KK, Byers RM, Maor MH, Guillamondegui O, et al. Evaluation of the dose for postoperative radiation therapy of head and neck cancer: first report of a prospective randomized trial. Int J Radiat Oncol Biol Phys. 1993;26:3–11.PubMed
44.
Vikram B. Postoperative irradiation for squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys. 1990;18:267–8.PubMed
45.
Richardson LC, Pollack LA. Therapy insight: influence of type 2 diabetes on the development, treatment and outcomes of cancer. Nat Clin Pract Oncol. 2005;2:48–53.CrossRefPubMed
46.
Fagan JJ, Collins B, Barnes L, D’Amico F, Myers EN, Johnson JT. Perineural invasion in squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg. 1998;124:637–40.PubMed
47.
Rahima B, Shingaki S, Nagata M, Saito C. Prognostic significance of perineural invasion in oral and oropharyngeal carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97:423–31.CrossRefPubMed
48.
O’Brien CJ, Lahr CJ, Soong SJ, Gandour MJ, Jones JM, Urist MM, et al. Surgical treatment of early-stage carcinoma of the oral tongue—wound adjuvant treatment be beneficial? Head Neck Surg. 1986;8:401–8.CrossRefPubMed
49.
Brown B, Barnes L, Mazariegos J, Taylor F, Johnson J, Wagner RL. Prognostic factors in mobile tongue and floor of mouth carcinoma. Cancer. 1989;64:1195–202.CrossRefPubMed
50.
Soo KC, Carter RL, O’Brien CJ, Barr L, Bliss JM, Shaw HJ. Prognostic implications of perineural spread in squamous carcinomas of the head and neck. Laryngoscope. 1986;96:1145–8.CrossRefPubMed
51.
Maddox WA. Hayes Martin lecture. Vicissitudes of head and neck cancer. Am J Surg. 1984;148:428–32.CrossRefPubMed
52.
53.
Kotelevets L, Noe V, Bruyneel E, Myssiakine E, Chastre E, Mareel M, et al. Inhibition by platelet-activating factor of Src- and hepatocyte growth factor-dependent invasiveness of intestinal and kidney epithelial cells. Phosphatidylinositol 3′-kinase is a critical mediator of tumor invasion. J Biol Chem. 1998;273:14138–45.CrossRefPubMed
54.
Hazan RB, Phillips GR, Qiao RF, Norton L, Aaronson SA. Exogenous expression of N-cadherin in breast cancer cells induces cell migration, invasion, and metastasis. J Cell Biol. 2000;148:779–90.CrossRefPubMed
55.
Li G, Satyamoorthy K, Herlyn M. N-cadherin-mediated intercellular interactions promote survival and migration of melanoma cells. Cancer Res. 2001;61:3819–25.PubMed
56.
Tran NL, Adams DG, Vaillancourt RR, Heimark RL. Signal transduction from N-cadherin increases Bcl-2. Regulation of the phosphatidylinositol 3-kinase/Akt pathway by homophilic adhesion and actin cytoskeletal organization. J Biol Chem. 2002;277:32905–14.CrossRefPubMed
57.
Vairaktaris E, Spyridonidou S, Goutzanis L, Vylliotis A, Lazaris A, Donta I, et al. Diabetes and oral oncogenesis. Anticancer Res. 2007;27:4185–93.PubMed
Metadata
Title
Impact of Diabetes Mellitus on the Prognosis of Patients with Oral Squamous Cell Carcinoma: A Retrospective Cohort Study
Authors
Cheng-Hsien Wu, DDS
Tzu-Ying Wu, DDS
Chia-Chen Li, DDS
Man-Tin Lui, DDS
Kuo-Wei Chang, DDS, PHD
Shou-Yen Kao, DDS, DMSc
Publication date
01-08-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 8/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-0996-1

Other articles of this Issue 8/2010

Annals of Surgical Oncology 8/2010 Go to the issue

Gastrointestinal Oncology

Improved Long-Term Quality of Life in Patients with Laparoscopy-Assisted Distal Gastrectomy with Jejunal Pouch Interposition for Early Gastric Cancer

Translational Research and Biomarkers

Epigenetic Inactivation of the Thyroid Hormone Receptor β1 Gene at 3p24.2 in Lung Cancer

Colorectal Cancer

Preoperative Staging with Chest CT in Patients with Colorectal Carcinoma: Not as a Routine Procedure

Colorectal Cancer

Stromal CXCR4 and CXCL12 Expression is Associated with Distant Recurrence and Poor Prognosis in Rectal Cancer After Chemoradiotherapy

Bone and Soft Tissue Sarcomas

Soft Tissue Sarcoma of Extremities: The Prognostic Significance of Adequate Surgical Margins in Primary Operation and Reoperation After Recurrence

Hepatobiliary Tumors

Sequenced Chemotherapy and Surgery for Potentially Resectable Colorectal Liver Metastases: A Debate Over Goals of Research and an Approach While the Jury Remains Out