Disease-Specific Mortality and Secondary Primary Cancer in Well-Differentiated Thyroid Cancer with Type 2 Diabetes Mellitus

Szu-Tah Chen,Jen-Der Lin,Wen-Ko Chiou,Chuen Hsueh

doi:10.1371/journal.pone.0055179

Szu-Tah Chen, Jen-Der Lin + Show 2 more

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https://doi.org/10.1371/journal.pone.0055179

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Journal: PloS one	Publication Date: Jan 31, 2013
Citations: 17	License type: CC BY 4.0

Affiliation: Chang Gung University, Chang Gung Memorial Hospital

Abstract

BackgroundIncreased body mass index is related to the incidence of thyroid cancer. However, the presentation and therapeutic outcomes of different thyroid cancers and type 2 diabetes mellitus (DM) have not been studied. This study investigated the effect of type 2 DM on the clinical presentations and therapeutic outcome of well-differentiated thyroid cancer.Methods and FindingsA retrospective analysis of adult thyroid cancer patients with or without type 2 DM admitted between January 2001 and December 2010 was performed at an institution. A total of 1,687 well-differentiated thyroid cancer patients with different histological patterns were enrolled. Among these subjects, 122 were type 2 DM patients. Patients with thyroid cancer and type 2 DM were significantly older than non-DM patients. After a mean follow-up period of 5.6±0.1 years, patients with thyroid cancer and type 2 DM showed a higher percentage of disease progression than non-DM patients (24.6% vs. 17.4%). In addition, disease-specific mortality was higher in the type 2 DM group (10.7% vs. 3.8%). Thyroid cancer patients with type 2 DM showed a higher percentage of secondary primary cancers than those without DM (10.7% vs. 4.9%). Thyroid cancer-specific survival rates in the type 2 DM and non-DM groups were 82.2% and 94.9% at 5 years, 72.9% and 91.4% at 10 years, and 36.5% and 61.3% at 20 years, respectively. Multivariate analysis showed that type 2 DM was independent of thyroid cancer-specific mortality.ConclusionPatients with type 2 DM and well-differentiated thyroid cancer had an advanced tumor-node-metastasis stage at the time of diagnosis and an increased disease-specific mortality. Aggressive surgical procedures and close follow-up for well-differentiated thyroid cancer patients with type 2 DM are therefore necessary.

Highlights

Cancer and diabetes mellitus (DM) as well as the associated cardiovascular complications are major health problems in developed and developing countries
In 2 recent reports, insulin resistance and obesity have been shown to increase the incidence of thyroid cancer [5,6]; in another recent report, a higher body mass index (BMI) has been shown to be correlated with a lower incidence of thyroid cancer for all patients, except women .45 years of age [7]
One possible interpretation of these contradictory findings is that hyperinsulinemia in the initial stage of type 2 DM may increase cancer growth, and the anovulatory status of older women with type 2 DM may decrease the development of thyroid cancer

Summary

Introduction

Cancer and diabetes mellitus (DM) as well as the associated cardiovascular complications are major health problems in developed and developing countries. The incidence of thyroid cancer has reportedly increased in Taiwan and other developed countries over the last 10 years [3,4]. In 2 recent reports, insulin resistance and obesity have been shown to increase the incidence of thyroid cancer [5,6]; in another recent report, a higher body mass index (BMI) has been shown to be correlated with a lower incidence of thyroid cancer for all patients, except women .45 years of age [7]. Increased body mass index is related to the incidence of thyroid cancer. The presentation and therapeutic outcomes of different thyroid cancers and type 2 diabetes mellitus (DM) have not been studied. This study investigated the effect of type 2 DM on the clinical presentations and therapeutic outcome of well-differentiated thyroid cancer

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Conclusion