目的:早发性结直肠癌(EoCRC)占所有结直肠癌的2%-10%,并且在全球范围内变得越来越普遍。糖尿病(DM)在年轻人中大幅增加;然而,其参与EoCRC的情况尚不清楚。我们对观察性研究进行了系统回顾和荟萃分析,以(1)探讨EoCRC患者中DM的患病率,以及(2)研究DM与EoCRC之间的关联。
方法:进行了系统的文献检索,以确定2022年5月之前发表的四个数据库中评估DM和EoCRC风险之间关联的研究。包括Medline(PubMed),Embase,WebofScience,和Cochrane中央受控试验登记册。使用随机效应模型在荟萃分析中总结了研究结果。
结果:纳入19项符合条件的研究。12项研究中共有33,359例EoCRC病例和14,259,289例对照纳入荟萃分析。合并比值比[OR]为1.43(95%置信区间[CI]:1.08-1.8)表明DM与EoCRC风险增加之间存在显著正相关。亚组分析表明,糖尿病严重程度与未管理的DM显着相关(OR=1.28,95%CI:1.02-1.6),但不是管理DM(OR=1.04,95%CI:0.84-1.28)。
结论:我们的结果表明DM是EoCRC的危险因素,而年轻成人中DM患病率较高可能导致EoCRC发病率增加.应进一步研究降低这种双向风险的干预措施,以制定有效的预防和治疗策略。PROSPERO注册:CRD42022306347。
OBJECTIVE: Early-onset colorectal cancer (EoCRC) constitutes 2%-10% of all colorectal cancers and is becoming more common globally. Diabetes mellitus (DM) has increased substantially in younger adults; however, its involvement in EoCRC remains unclear. We conducted a systematic
review and meta-analysis of observational studies to (1) explore the prevalence of DM in individuals with EoCRC and (2) investigate the association between DM and EoCRC.
METHODS: A systematic literature search was conducted to identify studies published before May 2022 that evaluated the association between DM and EoCRC risk in four databases, including Medline (PubMed), Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. Results from the studies were summarized in meta-analyses using random effects models.
RESULTS: Nineteen eligible studies were included. A total of 33,359 EoCRC cases and 14,259,289 controls in 12 studies were included in the meta-analysis. The pooled odds ratio [OR] of 1.43 (95% confidence interval [CI]: 1.08-1.8) indicated significant positive association between DM and increased risk of EoCRC. Subgroup analysis demonstrated that diabetes severity was significantly associated with unmanaged DM (OR = 1.28, 95% CI: 1.02-1.6), but not with managed DM (OR = 1.04, 95% CI: 0.84-1.28).
CONCLUSIONS: Our results suggest that DM is a risk factor for EoCRC, and the higher prevalence of DM among younger adults may contribute to the increasing incidence of EoCRC. Interventions to reduce this bidirectional risk should be further investigated for the development of effective prevention and treatment strategies. PROSPERO registration: CRD42022306347.