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Original Investigation |

Risk of Head and Neck Cancer in Patients With Diabetes Mellitus:  A Retrospective Cohort Study in Taiwan

Kuo-Shu Tseng, PhD1; Charlene Lin, BA2; Yung-Song Lin, MD3,4; Shih-Feng Weng, PhD5,6
[+] Author Affiliations
1Department of Food and Beverage Services, Tainan University of Technology, Tainan, Taiwan
2Department of Molecular and Cell Biology, University of California, Berkeley
3Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
4Department of Otolaryngology, Chi Mei Medical Center, Tainan, Taiwan
5Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
6Department of Hospital and Health Care Administration, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
JAMA Otolaryngol Head Neck Surg. 2014;140(8):746-753. doi:10.1001/jamaoto.2014.1258.
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Importance  An increasing body of evidence suggests that certain types of cancers are more common in people with diabetes mellitus (DM). However, the risk of head and neck cancer (HNC) in patients with DM has seldom been explored.

Objective  To examine the risk of HNC in patients with DM.

Design, Setting, and Participants  In this retrospective cohort study using Taiwan’s Longitudinal Health Insurance Research Database, we compared 89 089 patients newly diagnosed as having DM and controls without DM-related medical claims matched for comorbidities (obesity, coronary artery disease, hyperlipidemia, and hypertension), sex, and age. Patients were assessed from the index date until the end of follow-up on December 31, 2011, or until the patient was censored because of death.

Main Outcomes and Measures  The incidence of HNC at the end of 2011.

Results  The incidence of HNC was 1.47 times higher in patients newly diagnosed as having DM than was the risk of a first malignant tumor in the control group (adjusted hazard ratio [AHR], 1.48; 95% CI, 1.31-1.67). The risks of oral cancer (AHR, 1.74; 95% CI, 1.47-2.06), oropharyngeal cancer (AHR, 1.53; 95% CI, 1.01-2.31), and nasopharyngeal carcinoma (AHR, 1.40; 95% CI, 1.03-1.89) were significantly higher in patients with DM than in controls.

Conclusions and Relevance  Diabetes is associated with an increased risk of developing HNC. The risks of developing oral cavity cancer, oropharyngeal cancer, and nasopharyngeal carcinoma were significantly higher in patients with DM.

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Figure 1.
Cumulative Incidence in Taiwan of Head and Neck Cancer (HNC) in Patients With Newly Diagnosed Diabetes Mellitus (DM) and Matched Controls Without DM

Cumulative incidence in Taiwan of HNC in patients with DM and non-DM matched controls since the index date (2002) (log-rank P < .001). Each patient was assessed from the index date until the end of the follow-up on December 31, 2011, or until the patient was censored because of death.

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Figure 2.
Cumulative Survival Probability of Patients With Diabetes Mellitus (DM) Who Subsequently Developed Head and Neck Cancer (HNC)

Cumulative survival probability of patients with DM who subsequently developed HNC (group A), patients with DM who did not subsequently develop HNC (group B), patients without DM who subsequently developed HNC (group C), and patients without DM who did not subsequently develop HNC (group D). For the survival probability of patients who subsequently developed HNC, there was no significant difference (P = .22) in survival probabilities between the DM and the non-DM cohorts. P < .001 for all other comparisons (group A vs B, group B vs D, and group C vs D). Each patient was assessed from the index date to the end of follow-up on December 31, 2011, or until the patient was censored because of death.

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Figure 3.
Cumulative Survival Probability of Patients With Diabetes Mellitus (DM) Who Subsequently Developed Oral Cavity Cancer

Cumulative survival probability of patients with DM who subsequently developed oral cavity cancer (group A), patients with DM who did not subsequently develop oral cavity cancer (group B), patients without DM who subsequently developed oral cavity cancer (group C), and patients without DM who did not subsequently develop oral cavity cancer (group D). For the survival probability of patients who subsequently developed oral cavity cancer, there was no significant difference (P = .36) in survival probabilities between the DM and the non-DM cohorts. P < .001 for all other comparisons (group A vs B, group B vs D, and group C vs D). Each patient was assessed from the index date to the end of follow-up on December 31, 2011, or until the patient was censored because of death.

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Figure 4.
Cumulative Survival Probability of Patients With Diabetes Mellitus (DM) Who Subsequently Developed Oropharyngeal Cancer

Cumulative survival probability of patients with DM who subsequently developed oropharyngeal cancer (group A), patients with DM who did not subsequently develop oropharyngeal cancer (group B), patients without DM who subsequently developed oropharyngeal cancer (group C), and patients without DM who did not subsequently develop oropharyngeal cancer (group D). For the survival probability of patients who subsequently developed oropharyngeal cancer, there was no significant difference (P = .22) in survival probabilities between the DM and non-DM cohorts. P < .001 for all other comparisons (group A vs B, group B vs D, and group C vs D). Each patient was assessed from the index date to the end of follow-up on December 31, 2011, or until the patient was censored because of death.

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Figure 5.
Cumulative Survival Probability of Patients With Diabetes Mellitus (DM) Who Subsequently Developed Nasopharyngeal Cancer (NPC)

Cumulative survival probability of patients with DM who subsequently developed NPC (group A), patients with DM who did not subsequently develop NPC (group B), patients without DM who subsequently developed NPC (group C), and patients without DM who did not subsequently develop NPC (group D). For the survival probability of patients who subsequently developed NPC, there was no significant difference (P = .07) in survival probabilities between the DM and the non-DM cohorts. P < .001 for all other comparisons (group A vs B, group B vs D, and group C vs D). Each patient was assessed from the index date to the end of follow-up on December 31, 2011, or until the patient was censored because of death.

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