Type 1 and Type 2 Diabetes and Cancer Mortality in the 2002-2009 Cohort of 39 811 French Dialyzed Patients

Abstract

End-stage renal disease is a chronic and progressive pathology associated with several comorbidities, particularly diabetes. Indeed, diabetes is the first cause of end-stage renal disease and, in France, 42% of incident patients had diabetes in 2012. In the general population, diabetes is associated with increased cancer risk. The aim of this study was to examine the association between risk of cancer death and diabetes in a large French cohort of patients with end-stage renal disease. Data on all patients with end-stage renal disease who initiated dialysis in France between 2002 and 2009 were extracted from the Renal Epidemiology Information Network registry. The risk of dying by cancer was studied using the Fine and Gray model to take into account the competing risk of death by other causes. We analyzed 39 811 patients with end-stage renal disease. Their mean age was 67.7±15 years, 39.4% had diabetes and 55.3% at least one cardiovascular disease. Compared with the non-diabetic group, patients with diabetes were older and had more cardiovascular and respiratory comorbidities when they started dialysis. Conversely, fewer diabetic patients had also a tumor at the beginning of the renal replacement therapy. Cancer was indicated as the cause of death for 6.7% of diabetic and 13.4% of non-diabetic patients. The Fine and Gray multivariate analyses indicated that diabetes (HR=0.72 95% CI: [0.68-0.95], p<0.001) and also female gender, peritoneal dialysis, cardio-vascular disease and kidney transplantation were associated with decreased risk of death by cancer. In this French cohort of patients with end-stage renal disease, diabetes was not associated with a significant increased risk of dying from cancer. Studies on the incidence of cancer in patients with ESRD are now needed to evaluate the potential association between diabetes and specific malignancies in this population.

Diabetes Mellitus and Cause-Specific Mortality: A Population-Based Study

“…Data from the Strong Heart Study in the United States show that diabetes increases the risk of cancer mortality by 1.27-fold in American Indians [32]. Data analyses from a French cohort suggest that diabetes is not associated with cancer mortality in patients with end-stage renal disease [33]. For specific types of cancer, a consistent positive association between baseline diabetes and mortality due to liver, pancreas, or bladder cancer has been reported, although the relationship between diabetes and endometrial cancer mortality is inconsistent [30].…”

Tiroid Kanserlerinde Histomorfolojik Bulguların Değerlendirilmesi ve Diyabet ile Birlikteliği

“…2003 yılında araştırmacılar, DM tanısı olan kadınlarla olmayanlar kıyaslandığında, DM'li kadınlarda %17 oranında artmış meme kanseri insidansı riski bildirmişlerdir (2). Ancak bunun aksini belirten çalışmalar da literatürde mevcuttur (3)(4)(5). DM-kanser komorbiditesi çalışmalarında görülen bu tutarsız sonuçlar, en sık görülen endokrin kanser olan tiroid kanserinde de mevcuttur.…”

The association between diabetes and thyroid cancer risk: a hospital-based case-control study in China

“…As the global burden of diabetes and cancer grow, an increasing number of studies have been exploring the interrelationships between them, among which the majority focuses on the occurrence and prognosis of cancer among people with diabetes. Interestingly, elevated incidence and mortality in overall or specific types of cancer in diabetes patients have been reported in some studies [3][4][5][6], but not in others [7][8][9]. Among diabetes patients, the inconsistent incident risk also extends to thyroid cancer, which is the most common endocrine cancer [10].…”