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Chang ZY, Gao WX, Zhang Y, Chen P, Zhao W, Wu D, Chen ZD, Gao YH, Liang WQ, Chen L, Xi HQ. Development and validation of a nomogram to predict postsurgical intra-abdominal infection in blunt abdominal trauma patients: A multicenter retrospective study. Surgery 2024; 175:1424-1431. [PMID: 38402039 DOI: 10.1016/j.surg.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/23/2023] [Accepted: 01/13/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Intra-abdominal infection is a common complication of blunt abdominal trauma. Early detection and intervention can reduce the incidence of intra-abdominal infection and improve patients' prognoses. This study aims to construct a clinical model predicting postsurgical intra-abdominal infection after blunt abdominal trauma. METHODS This study is a retrospective analysis of 553 patients with blunt abdominal trauma from the Department of General Surgery of 7 medical centers (2011-2021). A 7:3 ratio was used to assign patients to the derivation and validation cohorts. Patients were divided into 2 groups based on whether intra-abdominal infection occurred after blunt abdominal trauma. Multivariate logistic regression and least absolute shrinkage and selection operator regression were used to select variables to establish a nomogram. The nomogram was evaluated, and the validity of the model was further evaluated by the validation cohort. RESULTS A total of 113 were diagnosed with intra-abdominal infection (20.4%). Age, prehospital time, C-reactive protein, injury severity score, operation duration, intestinal injury, neutrophils, and antibiotic use were independent risk factors for intra-abdominal infection in blunt abdominal trauma patients (P < .05). The area under the receiver operating curve (area under the curve) of derivation cohort and validation cohort was 0.852 (95% confidence interval, 0.784-0.912) and 0.814 (95% confidence interval, 0.751-0.902). The P value for the Hosmer-Lemeshow test was .135 and .891 in the 2 cohorts. The calibration curve demonstrated that the nomogram had a high consistency between prediction and practical observation. The decision curve analysis also showed that the nomogram had a better potential for clinical application. To facilitate clinical application, we have developed an online at https://nomogramcgz.shinyapps.io/IAIrisk/. CONCLUSION The nomogram is helpful in predicting the risk of postoperative intra-abdominal infection in patients with blunt abdominal trauma and provides guidance for clinical decision-making and treatment.
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Affiliation(s)
- Zheng Y Chang
- Medical School of Chinese PLA, Beijing, China; Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wen X Gao
- Medical School of Chinese PLA, Beijing, China; Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yue Zhang
- Medical School of Chinese PLA, Beijing, China; Department of Endocrinology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peng Chen
- Medical School of Chinese PLA, Beijing, China; Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wen Zhao
- Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China; School of Medicine, Nankai University, Tianjin, China
| | - Di Wu
- Medical School of Chinese PLA, Beijing, China; Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhi D Chen
- Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yun H Gao
- Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wen Q Liang
- Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lin Chen
- Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Hong Q Xi
- Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
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Chen F, Xue Q, He N, Zhang X, Li S, Zhao C. The association and application of sonodynamic therapy and autophagy in diseases. Life Sci 2023; 334:122215. [PMID: 37907152 DOI: 10.1016/j.lfs.2023.122215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023]
Abstract
Sonodynamic therapy (SDT) is a new non-invasive treatment method proposed based on photodynamic therapy (PDT). It has advantages such as high precision, strong tissue penetration, minimal side effects, and good patient compliance. With the maturation of nanomedicine, the application of nanosonosensitizers has further propelled the development of SDT. In recent years, people have developed many new types of sonosensitizers and explored the mechanisms of SDT. Among them, the studies about the relationship between autophagy and SDT have attracted increasing attention. After the SDT, cells usually undergo autophagy as a self-protective mechanism to resist external stimuli and reduce cell damage, which is beneficial for the treatment of atherosclerosis (AS), diabetes, and myocardial infarction but counterproductive in cancer treatment. However, under certain treatment conditions, excessive upregulation of autophagy can also promote cell death, which is beneficial for cancer treatment. This article reviews the latest research progress on the relationship between SDT and autophagy in cancers, AS, diabetes, and myocardial infarction. We also discuss and propose the challenges and prospects in enhancing SDT efficacy by regulating autophagy, with the hope of promoting the development of this promising therapeutic approach.
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Affiliation(s)
- Fang Chen
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Qingwen Xue
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ningning He
- School of Basic Medicine, Qingdao Medical College, Qingdao University, Qingdao, China
| | - Xuehui Zhang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shangyong Li
- School of Basic Medicine, Qingdao Medical College, Qingdao University, Qingdao, China.
| | - Cheng Zhao
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Zhou J, Fu J, Zhao Q, Lin S, Zhu H. Effect of neutrophil-to-lymphocyte ratio on short-term prognosis of elderly patients with hip fracture. Am J Transl Res 2021; 13:9122-9128. [PMID: 34540026 PMCID: PMC8430054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the effect of neutrophil-to-lymphocyte ratio (NLR) on short-term prognosis in elderly patients with hip fracture. METHODS Altogether, 124 elderly patients with hip fractures who underwent surgery in our hospital were retrospectively studied, and they were divided into survival group (n=98) and death group (n=26) according to their 1-year survival. General data of both groups were collected and compared, and indicators with statistical differences in univariate analysis were further examined by logistic regression analysis. Venous blood samples were drawn from all patients 1 day after the surgery to detect and compare NLR, serum procalcitonin (PCT) and C-reactive protein (CRP) levels between both groups. ROC curve was used to analyze the clinical value of NLR in predicting the prognosis of patients. NLR cutoff value obtained by the ROC curve analysis was adopted to divide the patients into high and low ratio groups, and Kaplan-Meier (K-M) curves were used to assess the survival rate of patients in both groups. RESULTS There were significant differences in age, gender, marital status, medical history and American Society of Anesthesiologists (ASA) grades between both groups. Logistic regression analysis showed that advanced age (≥85 years), male gender, and higher ASA grades (III-IV) were risk factors for short-term poor prognosis in elderly patients with hip fracture. Compared with survival group, NLR, PCT and CRP levels were higher in death group. ROC curve showed that the AUC of NLR predicting patients' prognosis was 0.804 at a cutoff value of 6.939%. K-M curves showed that the overall survival was lower in high-ratio group than in low-ratio group. CONCLUSION Advanced age (overall survival was lower in high-ratio group than in low-ratio group), male gender, and higher ASA grades (III-IV) were risk factors for short-term poor prognosis in elderly patients with hip rifracture. NLR has some clinical value in predicting and evaluating the prognosis of patients.
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Affiliation(s)
- Jihui Zhou
- Department of Traumatic Orthopedics, Maoming People’s HospitalMaoming, Guangdong Province, China
| | - Jidong Fu
- Department of Traumatic Surgery, Longnan Hospital of Daqing, The Fifth Hospital Affiliated to Qiqihar Medical UniversityDaqing, Heilongjiang Province, China
| | - Qiang Zhao
- Department of Orthopedics, The Second People’s Hospital of RizhaoRizhao, Shandong Province, China
| | - Shibang Lin
- Department of Traumatic Orthopedics, Maoming People’s HospitalMaoming, Guangdong Province, China
| | - Haiming Zhu
- Department of Traumatic Orthopedics, Maoming People’s HospitalMaoming, Guangdong Province, China
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Zhou T, Zheng N, Li X, Zhu D, Han Y. Prognostic value of neutrophil- lymphocyte count ratio (NLCR) among adult ICU patients in comparison to APACHE II score and conventional inflammatory markers: a multi center retrospective cohort study. BMC Emerg Med 2021; 21:24. [PMID: 33622247 PMCID: PMC7903782 DOI: 10.1186/s12873-021-00418-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/15/2021] [Indexed: 12/29/2022] Open
Abstract
Background Neutrophil-lymphocyte count ratio (NLCR) has been reported as better indicator of bacteremia than procalcitonin (PCT), and more precise predictor of mortality than C-reactive protein (CRP) under various medical conditions. However, large controversy remains upon this topic. To address the discrepancy, our group has compared the efficiency of NLCR with conventional inflammatory markers in predicting the prognosis of critical illness. Methods We performed a multi-center retrospective cohort study involving 536 ICU patients with outcomes of survival, 28- and 7-day mortality. NLCR was compared with conventional inflammatory markers such as PCT, CRP, serum lactate (LAC), white blood cell, neutrophil and severity score APACHE II (Acute Physiology and Chronic Health Evaluation II) to evaluate the potential outcomes of critical illness. Then, receiver operating characteristics (ROC) curves were constructed to assess and compare each marker’s sensitivity and specificity respectively. Results NLCR values were not different between survival and mortality groups. Meanwhile, remarkable differences were observed upon APACHE II score, CRP, PCT and LAC levels between survival and death groups. ROC analysis revealed that NLCR was not competent to predict prognosis of critical illness. The AUROCs of conventional markers such as CRP, PCT, LAC and APACHE II score were more effective in predicting 28- and 7-day mortality. Conclusions NLCR is less reliable than conventional markers CRP, PCT, LAC and APACHE II score in assessing severity and in predicting outcomes of critical illness. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00418-2.
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Affiliation(s)
- Tao Zhou
- Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Nan Zheng
- Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiang Li
- Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Dongmei Zhu
- Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yi Han
- Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Achkasov SI, Sukhina MA, Sushkov OI, Nabiev EN, Shakhmatov DG, Tarasov MA, Moskalev AI. [The role of neutrophil CD64 index in the diagnosis of infectious complications after colorectal resection]. Khirurgiia (Mosk) 2020:29-35. [PMID: 33047583 DOI: 10.17116/hirurgia202010129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine diagnostic value of neutrophil CD64 index (iCD64n) in the diagnosis of postoperative infectious complications after colorectal resections. MATERIAL AND METHODS Seventy-three patients underwent colorectal surgery for the period from January to December 2018. These patients were included into a single-center study. Peripheral blood samples were taken on 3 and 6 postoperative days (POD) to check iCD64n level. We analyzed incidence of postoperative infectious complications, sensitivity (Se) and specificity (Sp) of postoperative iCD64n level on the 3rd and 6th POD. RESULTS Postoperative infectious complications developed in 10 (13.7%) patients. Median iCD64n was significantly higher (p=0.0017 for POD 3; p=0.018 for POD 6) in patients with infectious complications (1.6 on POD 3; 1.3 on POD 6) compared to those without complications (1.1 on POD 3; 0.9 on POD 6). Area under curve (AUC) on the 3rd POD was 0.8 with the cut-off value of 1.4, Se - 70%, Sp - 93.7% (p=0.002). On the 6th POD, AUC was 0.91 with cut-off value of 1.23, Se - 80%, Sp - 93.7% (p<0.001). CONCLUSION Neutrophil CD64 index is a valuable predictor for the diagnosis of postoperative infectious complications after colorectal resections. It is a useful tool to ensure a safe early discharge. The study is registered on the website «clinictrials.gov» (registration number NCT03559335).
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Affiliation(s)
- S I Achkasov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - M A Sukhina
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - O I Sushkov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - E N Nabiev
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - D G Shakhmatov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - M A Tarasov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - A I Moskalev
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
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Applicability of common inflammatory markers in diagnosing infections in early period after liver transplantation in intensive care setting. Sci Rep 2020; 10:3918. [PMID: 32127631 PMCID: PMC7054413 DOI: 10.1038/s41598-020-60936-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022] Open
Abstract
Infections remain an important cause of morbidity and mortality early after liver transplantation. The aim of this prospective longitudinal study was to evaluate clinical utility of c-reactive protein (CRP), procalcitonin, and neutrophil-to-lymphocyte ratio (NLR) in surveillance of infections early after liver transplantation in intensive care setting. A total of 60 liver transplant recipients were included. CRP, procalcitonin, and NLR assessed at 12-hour intervals were primary variables of interest. Infections and severe complications during postoperative intensive care unit stay were the primary and secondary end-points, respectively. Infections and severe complications were diagnosed in 9 and 17 patients, respectively. Only peak CRP beyond first 48 hours was associated with infections (p = 0.038) with AUC, positive and negative predictive value of 0.728, 42.9% and 92.2%, respectively (cut-off: 142.7 mg/L). Peak procalcitonin over first 60 hours was the earliest predictor (p = 0.050) of severe complications with AUC, positive and negative predictive value of 0.640, 53.3% and 80.0%, respectively (cut-off: 42.8 ng/mL). In conclusion, while CRP, procalcitonin, and NLR cannot be used for accurate diagnosis of infections immediately after liver transplantation, peak CRP beyond 48 hours and peak procalcitonin over first 60 hours may be used for initial exclusion of infections and prediction of severe complications, respectively.
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Inose H, Kobayashi Y, Yuasa M, Hirai T, Yoshii T, Okawa A. Procalcitonin and Neutrophil Lymphocyte Ratio After Spinal Instrumentation Surgery. Spine (Phila Pa 1976) 2019; 44:E1356-E1361. [PMID: 31725684 DOI: 10.1097/brs.0000000000003157] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN This was a retrospective observational study. OBJECTIVE To assess the diagnostic value of procalcitonin (PCT) and neutrophil lymphocyte ratio (NLR) for predicting surgical site infection (SSI) in patients undergoing spinal instrumentation surgery, we analyzed a large consecutive cohort of patients who had undergone spinal instrumentation surgery. SUMMARY OF BACKGROUND DATA Although PCT and NLR are commonly used as markers for bacterial infection, the diagnostic value of these factors for predicting SSI in the context of spinal instrumentation surgery has not been extensively investigated. METHODS We retrospectively investigated 242 patients who underwent spinal instrumentation surgery and evaluated the significance of various postoperative measures for predicting SSI, including PCT and NLR. We then determined the diagnostic cut-off values for these markers in the prediction of SSI using receiver operating characteristic curve analysis. RESULTS Among the 242 patients analyzed, 10 were diagnosed with infection. Even though univariate analysis showed that neutrophil percentage and NLR at 6 to 7 days postoperatively were significant predictors for SSI, PCT at 6 to 7 days postoperatively did not differ significantly between the SSI and non-SSI groups. The cut-off value used for neutrophil percentage at 6 to 7 days postoperatively was more than 69.0% [sensitivity, 80.0%; specificity, 70.0%; area under the curve, 0.737]. The cut-off value used for NLR at 6 to 7 days postoperatively was 3.87 (sensitivity, 70.0%; specificity, 73.2%; area under the curve, 0.688). CONCLUSION Neutrophil percentage and NLR at 6 to 7 days postoperatively were more useful markers than PCT at 6 to 7 days postoperatively for early prediction of SSI in patients who had undergone spinal instrumentation surgery. Therefore, routine use of PCT as a predictor of postoperative infection is not supported by the results of this study. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Hiroyuki Inose
- Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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Mortaz E, Zadian SS, Shahir M, Folkerts G, Garssen J, Mumby S, Adcock IM. Does Neutrophil Phenotype Predict the Survival of Trauma Patients? Front Immunol 2019; 10:2122. [PMID: 31552051 PMCID: PMC6743367 DOI: 10.3389/fimmu.2019.02122] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 08/23/2019] [Indexed: 12/14/2022] Open
Abstract
According to the World Health Organization (WHO), trauma is responsible for 10% of deaths and 16% of disabilities worldwide. This is considerably higher than those for malaria, tuberculosis, and HIV/AIDS combined. While the human suffering and death caused by injury is well-recognized, injury has a significant medical care cost. Better prediction of the state of trauma patients in the days immediately after trauma may reduce costs. Traumatic injuries to multiple organs can cause dysfunction in all systems of the body especially the immune system placing patients at high risk of infections and inflammatory complications which are often fatal. Neutrophils are the most abundant leukocyte in the human circulation and are crucial for the prevention of microbial disease. Significant changes in neutrophil functions such as enhanced chemotaxis, Neutrophil extracellular trap (NET)-induced cell death (NETosis), and phagocytosis occur early after injury followed by prolonged functional defects such as phagocytosis, killing mechanisms, and receptor expression. Analysis of these changes may improve the prediction of the patient's condition over time. We provide a comprehensive and up-to-date review of the literature investigating the effect of trauma on neutrophil phenotype with an underlying goal of using this knowledge to examine the predictive potential of neutrophil alterations on secondary complications in patients with traumatic injuries. We conclude that alterations in neutrophil surface markers and functions may be potential biomarkers that predict the outcome of trauma patients.
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Affiliation(s)
- Esmaeil Mortaz
- Department of Immunology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Sajjad Zadian
- Department of Immunology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehri Shahir
- Department of Immunology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gert Folkerts
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Johan Garssen
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.,Nutricia Research Centre for Specialized Nutrition, Utrecht, Netherlands
| | - Sharon Mumby
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
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Long term survival in 200 patients with advanced stage of colorectal carcinoma and diabetes mellitus - a single institution experience. Radiol Oncol 2019; 53:238-244. [PMID: 31104000 PMCID: PMC6572493 DOI: 10.2478/raon-2019-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/07/2019] [Indexed: 11/21/2022] Open
Abstract
Background Diabetes mellitus (DM) and DM related comorbidities may initiate difficulties during cancer specific treatment and may have an impact on cancer management and outcome. The aim of our study was to find out if DM in patients with advanced colorectal carcinoma (CRC) is associated with cancer-specific or overall survival. Patients and methods This study included 200 consecutive patients (131 males, 69 females, mean age 63 years) with elective CRC surgery at the Institute of Oncology Ljubljana and DM was found in 39 (19.5%) of them. Even 64% of patients had Stage 3 or 4 disease, so neo-adjuvant chemotherapy (CTX) and/or radiotherapy (RT) were carried out in 59% of cases. Data about gender, age, body mass index, presence of DM, American Society of Anesthesiologists (ASA) physical status score, stage of disease and postoperative complications were collected prospectively. Cancer-specific survival and overall survival were compared by log-rank test. Results Patients with DM had a higher ASA score, BMI, the illness marker, rate of massive bleeding, blood transfusion and longer hospital stay than those without DM. The mean follow-up period was 4.75 years. All causes mortality in patients with DM and without DM was 23% and 27%, respectively. Three-year cancer-specific survival in patients with DM and without DM was 85% and 89%, respectively (p = 0.68). Three-year overall survival in patients with DM and without DM was 82% and 84%, respectively (p = 0.63). Conclusions The presence of DM was not associated with tumor stage, disease-specific survival or overall survival in patients with advanced CRC.
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