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编者按：众所周知，糖尿病为癌症发生的明确风险因素。有限证据表明，癌症可以增加新发生糖尿病的风险，但是该证据尚不明确、尚无定论。 2018年6月7日，《美国医学会杂志》肿瘤学分册在线发表韩国国家癌症中心、成均馆大学医学院三星首尔医院、美国霍普金斯大学布隆伯格公共卫生学院、西班牙公共卫生与流行病学生物医学研究联盟、卡洛斯三世公共卫生学院、国家流行病学中心的韩国全国队列（定群）研究报告，调查了癌症发生与此后糖尿病风险增加是否相关。结果，对52万4089位男性和女性韩国普通人群队列观察长达10年后发现，对于发生癌症的参与者，即使排除癌前糖尿病风险等因素影响之后，发生糖尿病的风险也显著增加。 该队列研究（定群調查）于2003年1月1日～2013年12月31日对覆盖全国人口2.2%的52万4089位20～70岁无糖尿病无癌症病史韩国普通人群样本（女性占50.0%，平均年龄41.8±12.5岁）进行观察长达10年，通过医疗保险索赔代码，分析新发癌症与2型糖尿病事件的相关性。 结果，对其中49万4189位参与者完成随访合计349万2935.6年（人均中位随访7.0年），发现1万5130位参与者发生癌症、2万6610位参与者发生糖尿病。 排除不同年龄、性别、癌前糖尿病风险因素、代谢因素、合并症的影响后，发生癌症与未发生癌症的参与者相比，随后发生糖尿病的风险显著增加35%（风险比：1.35，95%置信区间：1.26～1.45，P<0.001）。癌症诊断之后的头两年，发生糖尿病的风险增加最高，但是整个随访期间仍然保持增加。 根据不同的癌症发生部位，随后发生糖尿病的风险依次为：
因此，该大样本韩国队列研究结果表明，发生癌症增加了随后发生糖尿病的风险。这些数据提供证据表明，癌症存活者的糖尿病风险增加与癌症相关，而与传统的糖尿病风险因素无关。医生应该记住，癌症患者与非癌症患者相比，发生其他临床问题（例如糖尿病）风险较高，并且应该考虑对这些患者常规进行糖尿病筛查。 相关阅读 JAMA Oncol. 2018 Jun 7. [Epub ahead of print] Incidence of Diabetes After Cancer Development: A Korean National Cohort Study. Yul Hwangbo; Danbee Kang; Minwoong Kang; Saemina Kim; Eun Kyung Lee; Young Ae Kim; Yoon Jung Chang; Kui Son Choi; So-Youn Jung; Sang Myung Woo; Jin Seok Ahn; Sung Hoon Sim; Yun Soo Hong; Roberto Pastor-Barriuso; Eliseo Guallar; Eun Sook Lee; Sun-Young Kong; Juhee Cho. National Cancer Center, Goyang, Korea; Sungkyunkwan University, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; National Center for Epidemiology, Instituto de Salud Carlos III, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain. This Korean national cohort study investigates whether the development of cancer is associated with increasing risk of subsequent diabetes. QUESTION: Does cancer increase the risk of diabetes? FINDINGS: In a Korean general population cohort of 524089 men and women observed for up to 10 years, participants who developed cancer had a clear increase in the subsequent risk of diabetes, even after taking into account precancer risk factors. MEANING: Physicians should remember that patients with cancer develop other clinical problems, such as diabetes, with higher frequency than individuals without cancer, and should consider routine diabetes screening in these patients. IMPORTANCE: Diabetes is an established risk factor for developing cancer. A limited body of evidence also suggests that cancer can increase the risk of developing new cases of diabetes, but the evidence is inconclusive. OBJECTIVE: To evaluate whether the development of cancer is associated with increasing risk of subsequent diabetes. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included a nationally representative sample of the Korean general population observed for up to 10 years (January 1, 2003, to December 31, 2013). A total of 524089 men and women 20 to 70 years of age without diabetes and with no history of cancer at baseline were included. EXPOSURES: Incident cancer (time-varying exposure). MAIN OUTCOMES AND MEASURES: Incident type 2 diabetes using insurance claim codes. RESULTS: During 3492935.6 person-years of follow-up (median follow-up, 7.0 years) in 494189 individuals (50.0% female; mean [SD] age, 41.8 [12.5] years), 15130 participants developed cancer and 26610 participants developed diabetes. After adjustment for age, sex, precancer diabetes risk factors, metabolic factors, and comorbidities, the hazard ratio (HR) for diabetes associated with cancer development was 1.35 (95% CI, 1.26-1.45; P<.001). The excess risk for diabetes was highest in the first 2 years after cancer diagnosis, but it remained elevated throughout follow-up. By cancer type, development of pancreatic (HR, 5.15; 95% CI, 3.32-7.99), kidney (HR, 2.06; 95% CI, 1.34-3.16), liver (HR, 1.95; 95% CI, 1.50-2.54), gallbladder (HR, 1.79; 95% CI, 1.08-2.98), lung (HR, 1.74; 95% CI, 1.34-2.24), blood (HR, 1.61; 95% CI, 1.07-2.43), breast (HR, 1.60; 95% CI, 1.27-2.01), stomach (HR, 1.35; 95% CI, 1.16-1.58), and thyroid cancer (HR, 1.33; 95% CI, 1.12-1.59) was associated with a significantly increased risk of diabetes. CONCLUSIONS AND RELEVANCE: In this large Korean cohort, cancer development increased the risk of subsequent diabetes. These data provide evidence that cancer is associated with an increased risk of diabetes in cancer survivors independent of traditional diabetes risk factors. Physicians should remember that patients with cancer develop other clinical problems, such as diabetes, with higher frequency than individuals without cancer, and should consider routine diabetes screening in these patients. DOI: 10.1001/jamaoncol.2018.1684 |
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