论文快览！糖尿病与癌症的关系及其潜在机制
Frontiers in Endocrinology
内分泌学前沿
2022, Volume 13, Article 800995
The Relationship Between Diabetes Mellitus and Cancers and Its Underlying Mechanisms
The link between diabetes and cancer has been proposed for more than 100 years.
糖尿病和癌症之间的联系已被提出100多年。
The risk of cancers appears to be increased in both type I diabetes mellitus and type 2 diabetes mellitus.
1型和2型糖尿病似乎都会增加癌症风险。
Cancer incidence of liver, pancreas, kidney, esophagus, stomach, lung, thyroid, squamous cell carcinoma, and leukaemia significantly increased for both sexes with T1DM. Incidence of non-Hodgkin’s lymphoma and colon cancer significantly increased for men; while incidence of the ovary, esophagus, endometrium, vulva and vagina, and thyroid cancer significantly increased for women. On the contrary, incidences of prostate cancer and testis cancer significantly decreased in men with T1DM in comparison with the general population. Women with T1DM had significantly lower risk for breast cancer, melanoma, and Hodgkin’s lymphoma.
1型糖尿病患者的肝脏、胰腺、肾脏、食道、胃、肺、甲状腺、鳞状细胞癌和白血病的癌症发病率显著增加。男性非霍奇金淋巴瘤发病率显著增肌，女性卵巢癌、食管癌、子宫内膜癌和甲状腺癌发病率显著增加。
但相反地，与普通人相比，男性1型糖尿病患者前列腺癌症和睾丸癌的发病率显著降低，女性患者患乳腺癌症、黑色素瘤和霍奇金淋巴瘤的风险显著降低。
But, there was evidence of heterogeneity in risk of some cancers by country, and TIDM duration.
但是，有证据表明，某些癌症的风险因国家和1型糖尿病持续时间而异。
Significant positive associations between T2DM and mortality from cancers were observed for the cancers of stomach, colorectum, oral cavity, gallbladder, bile duct, liver, pancreas, ovary, endometrium, breast, thyroid, prostate, lung, kidney, bladder, and lymphoma. Controversially, some studies reported a null association between T2DM and the risk of death from cancers of the lung, bladder, stomach, cervix, esophagus, as well as leukaemia, suggesting that the role of diabetes in these site cancer needs further clarification.
在胃癌、结直肠癌、口腔癌、胆囊癌、胆管癌、肝脏癌、胰腺癌、卵巢癌、子宫内膜癌、乳腺癌、甲状腺癌、前列腺癌、肺癌、肾脏癌、膀胱癌和淋巴癌的病例中，观察到了2型糖尿病与癌症死亡率的显著正相关。
有争议的是，一些研究报告称，2型糖尿病与肺癌、膀胱癌、胃癌、宫颈癌、食道癌以及白血病死亡风险之间没有关联，上述作用需进一步澄清。
Genetic factors have been identified as contributing to the associations between diabetes and some cancers. For instance, individuals who have a family history of pancreatic cancer often have a higher risk of developing pancreatic cancer.
遗传因素已经被确定为糖尿病与某些癌症之间关联性的因素。
It is well known that most patients with prediabetes or T2DM have overweight or obesity. A large cohort study which included 900 000 individuals with an over 16-year duration of follow-up reported that severe obesity was associated with a significantly increased mortality from cancers of the liver, pancreas, colon and rectum, kidney, non-Hodgkins lymphoma, esophagus, and multiple myeloma. The greatest influences were observed in cancers of liver, colon and rectum, and pancreas.
众所周知，大多数糖尿病前期或2型糖尿病患者都有超重或肥胖。一项包括60万名随访时间超过16年的研究报告称，严重肥胖与肝癌、胰腺癌、结肠癌和直肠癌、肾癌、非霍奇金淋巴瘤、食道癌和多发性骨髓瘤的死亡率显著增加有关，肝癌、结肠癌、直肠癌和胰腺癌的影响最大。
Epidemiological data have shown that hyperglycemia is related to higher risk of colorectal, liver, gastric, lung and pancreatic cancer. Normally, cells differentiates rely on mitochondrial oxidative phosphorylation to provide the energy to cellular processes, while cancer cells tend to use a less efficient glycolytic pathway for proliferation. Cancer cells therefore require increased glucose uptake to generate sufficient energy hence meet their proliferation needs.
流行病学数据表明，高血糖与结直肠癌、肝癌、胃癌、肺癌和胰腺癌的高风险相关。正常情况下，细胞在分化过程中依赖线粒体氧化磷酸化提供能量，而癌症细胞一般使用效率较低的糖酵解进行增殖。因此，癌细胞需要更多葡萄糖摄取，以产生足够的能量，满足其增殖需要。
Numerous clinical studies and meta-analyses have demonstrated that diabetes exposure to metformin was associated with a significantly decreased cancer incidence and mortality.
大量临床研究和荟萃分析表明，糖尿病患者使用二甲双胍可显著降低癌症发病率和死亡率。
The use of DPP-IV inhibitor sitagliptin or the GLP-I analog exenatide was associated with a significant increase in the incidence of pancreatic cancer.
使用DPP-IV抑制剂西他列汀或GLP-I类似物艾塞那肽与胰腺癌发病率显著增加相关。
There is a complicated association between diabetes mellitus and cancers. In summary, the risk a number of cancers and cancer mortality is increased in T1DM and T2DM. On the other hand, some kinds of cancer and cancer therapies are associated with the increased risk of diabetes mellitus. Additionally, genetic factors, obesity, inflammation, oxidative stress, hyperglycemia, hyperinsulinemia, cancer therapies, insulin and some oral hypoglycemic drug appear to play a role in the crosstalk between diabetes mellitus and cancers. Thus, we suggest that cancer screening should be conducted in patients with diabetes, and precautions for diabetes should be taken in patients suffering from cancer. Further researches are merited to explore on the associations between these different diseases.
糖尿病和癌症之间有着复杂的关系。1型/2型患者患多种癌症的风险和癌症死亡率增加。另外，某些类型癌症和癌症治疗与糖尿病风险增加有关。此外，遗传因素、肥胖、炎症、氧化应激、高血糖、高胰岛素血症、癌症治疗、胰岛素和一些口服降糖药物似乎在糖尿病和癌症之间相互影响中发挥了作用。对糖尿病患者进行癌症筛查、对癌症患者采取糖尿病预防措施都是值得建议的。
