Abstract
We aimed to evaluate and determine the effect of diabetes mellitus (DM) on overall survival (OS) and cancer-specific survival (CSS) in early stage cervical cancer (CC) patients. Patients with primary cervical cancer and newly diagnosed were selected from ten different cancer specialist hospitals of Malaysia. Patients’ demographic and clinical data were obtained for the prognostic analysis. Kaplan-Meier method was used to estimate patients’ survival time (CSS and OS) with DM status and values were compared using the log-rank test. A total of 19,785 newly diagnosed CC patients were registered during 2010–2016, among them only 16,946 (85.6%) with primary CC tumor. There was no difference in treatment modality between DM and non-DM patients. However intergroup assessment showed that type 2DM have significantly higher rate of mortality in both overall mortality (28.3%) and CC-specific (11.7%) as compared to Type 1DM (17.3%; 5.5%) and non DM patients (12.7%; 9.1%) (p < 0.001). Within group assessments showed that Type 2DM patients have better quality of life (mean 7.13 ± 3.67) (p < 0.001) and less distress levels (mean 2.41 ± 0.63) (p < 0.011) as compared to type1 DM (meant 10.54 ± 2.11; 3.19 ± 1.07). This study concluded that T2DM prognostic effect still remained after adjusting demographic and clinical parameters. Type 1 diabetes mellitus showed better OS and CSS then type2 DM.
Highlights
Malaysia had estimated 4,696 reported cases of CC annually[1], ministry of health Malaysia stated an average of 2000–3000 hospital admissions of CC annually in the country; and majority of them presenting with late stages of the disease[5]
It was found that patients with diabetes mellitus (DM) were significantly probable to develop squamous cell carcinoma (SCC) (p < 0.048), high incidences of liver and cardiopulmonary comorbidities (p < 0.001), Stage IA/IB (p < 0.002) and nodule size ≤6 cm (p < 0.021) (Table 1)
Intergroup assessment showed that type 2DM have significantly higher rate of mortality in both overall mortality (28.3%) and CC-specific (11.7%) as compared to Type 1DM (17.3%; 5.5%) and non DM patients (12.7%; 9.1%) (p < 0.001)
Summary
Malaysia had estimated 4,696 reported cases of CC annually[1], ministry of health Malaysia stated an average of 2000–3000 hospital admissions of CC annually in the country; and majority of them presenting with late stages of the disease[5]. The pathological and clinical parameters influence on DM, the effect of diabetes on overall survival (OS) and cervical cancer (CC)-specific (cancer-specific survival – CSS) mortality among early stage CC has not been evaluated so far. The concern is focused on the interrelation of diabetes related psychosocial correlates and variability in glycemic index to disease outcome as well as treatment modalities. This hospital-based survival analysis study is the first of its kind; to determine the effect of DM on survival parameters like; OS and CSS among early stage CC patients and determine the effect to subclasses of DM., type 1 and 2 on the overall mortality and outcome. The psychosocial parameters like, quality of life tool and diabetes distress scale (DDS) were used to determine the impact on OS and CSS among patients with early stage CC and DM
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