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Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
380
Diabetes and Colorectal Cancer Risk and Survival According to Tumor Immunity Status
Durgesh Wankhede1,2, Niels Halama3,4,5, Matthias Kloor6,7
1Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Summary
Type 2 diabetes (T2D) increases colorectal cancer (CRC) risk and worsens survival, especially in tumors with low immune infiltration. Precision prevention strategies integrating metabolic and immune interventions are needed for T2D patients.
Area of Science:
- Oncology
- Immunology
- Metabolic Diseases
Background:
- Type 2 diabetes (T2D) is linked to higher colorectal cancer (CRC) risk and poorer outcomes.
- The influence of tumor immune status on the T2D-CRC relationship is not well understood.
Purpose of the Study:
- To investigate how tumor immune status modifies the association between T2D and CRC risk.
- To evaluate the impact of T2D on CRC survival based on tumor immune infiltration levels.
Main Methods:
- A population-based matched case-control study with long-term follow-up of 2,321 CRC cases.
- Tumor immune status assessed using an immune cell score (ICS) based on T-cell densities.
- Multivariable logistic and time-dependent Cox regression analyses used to estimate CRC risk and survival outcomes.
Main Results:
- T2D risk for CRC varied significantly by ICS (P = .02), with increased risk observed in low (OR, 1.80) and intermediate (OR, 1.42) ICS subtypes.
- Patients with T2D and low ICS tumors had poorer CRC-specific survival (HR, 1.99) and disease-free survival (HR, 1.53).
- T2D was associated with inferior overall survival regardless of immune subtype.
Conclusions:
- T2D disproportionately impacts CRC risk and survival in tumors with low immune infiltration.
- Findings suggest T2D influences tumorigenesis and prognosis via immune modulation.
- Precision prevention strategies combining metabolic and immune interventions are recommended for T2D patients at risk of CRC.
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