Postoperative Mortality in Cancer Patients With Preexisting Diabetes

Systematic review and meta-analysis

  1. Frederick L. Brancati, MD, MHS1,2
  1. 1Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland;
  2. 2Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland;
  3. 3Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland;
  4. 4Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland;
  5. 5Division of Endocrinology, Johns Hopkins School of Medicine, Baltimore, Maryland.
  1. Corresponding author: Hsin-ChiehYeh, hyeh1{at}jhmi.edu.

Abstract

OBJECTIVE Diabetes appears to increase risk for some cancers, but the association between preexisting diabetes and postoperative mortality in cancer patients is less clear. Our objective was to systematically review postoperative mortality in cancer patients with and without preexisting diabetes and summarize results using meta-analysis.

RSEARCH DESIGN AND METHODS We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica Database (EMBASE) for articles published on or before 1 July 2009, including references of qualifying articles. We included English language investigations of short-term postoperative mortality after initial cancer treatment. Titles, abstracts, and articles were reviewed by at least two independent readers. Study population and design, results, and quality components were abstracted with standard protocols by one reviewer and checked for accuracy by additional reviewers.

RESULTS Of 8,828 titles identified in our original search, 20 articles met inclusion criteria for qualitative systematic review. Of these, 15 reported sufficient information to be combined in meta-analysis. Preexisting diabetes was associated with increased odds of postoperative mortality across all cancer types (OR = 1.85 [95% CI 1.40–2.45]). The risk associated with preexisting diabetes was attenuated but remained significant when we restricted the meta-analysis to models that controlled for confounders (1.51 [1.13–2.02]) or when we accounted for publication bias using the trim and fill method (1.52 [1.13–2.04]).

CONCLUSIONS Compared with their nondiabetic counterparts, cancer patients with preexisting diabetes are ∼50% more likely to die after surgery. Future research should investigate physiologic pathways to mortality risk and determine whether improvements in perioperative diabetes care can reduce postoperative mortality.

Footnotes

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received September 15, 2009.
    • Accepted January 2, 2010.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

| Table of Contents