糖尿病對局部晚期食道癌患者術前化放療後病理反應與存活率之影響：一個以台灣人口為基礎的回溯性世代研究

研究目的　　本研究旨在探討罹患糖尿病（Diabetes Mellitus, DM）對接受術前同步化學放射治療（Neoadjuvant Concurrent Chemoradiotherapy, nCCRT）與手術之局部晚期食道癌患者，其病理完全緩解率（Pathologic Complete Response, pCR）及整體存活率（Overall Survival, OS）是否具有顯著影響。糖尿病作為常見代謝性共病，已在直腸癌與乳癌等領域被認為可能降低治療反應與生存率，但其在食道癌中的實證仍不足，尤其缺乏以全國性資料為基礎的分析。研究方法　　本研究為回溯性世代研究，使用2010至2019年間台灣的全民健康保險研究資料庫（NHIRD）、癌症登記檔（TCR）與死亡登記檔，納入共3,284位接受術前nCCRT與手術之新診斷食道癌患者，其中糖尿病組453人，非糖尿病組2,831人。主要觀察指標為術後病理完全緩解（pCR），次要觀察指標為整體存活率（OS）。分析方法包括邏輯斯迴歸與Cox比例風險模型，進行多變項調整與分層分析。 研究結果　　整體pCR比例為37.3%，糖尿病組與非糖尿病組間差異不顯著（aOR=1.17, 95% CI: 0.94–1.44）。整體死亡風險方面，糖尿病組與非糖尿病組之間無顯著差異（aHR=1.087, 95% CI: 0.954–1.238）。然而，部分亞群呈現異質性效果，例如年齡小於60歲者糖尿病組之pCR比例較高（aOR=1.34），而飲酒者則較低（aOR=0.50）。在達成pCR的族群中，糖尿病患者相較於非糖尿病者有較高的死亡率，雖經調整後未達統計顯著。結論　　本研究顯示，糖尿病對接受術前nCCRT與手術的局部晚期食道癌患者，並未顯著降低其病理反應或存活率，故不應作為治療排除條件。臨床應重視個別差異，並強化共病整合管理與個人化風險預測模型，以提升癌症治療的成效與公平性。

ObjectivesThis study aimed to evaluate the impact of diabetes mellitus (DM) on pathologic complete response (pCR) and overall survival (OS) in patients with locally advanced esophageal cancer treated with neoadjuvant concurrent chemoradiotherapy (nCCRT) followed by surgery. While DM has been linked to worse treatment responses and prognosis in cancers such as rectal and breast cancer, its influence on esophageal cancer remains unclear, especially in population-based studies.MethodsWe conducted a retrospective cohort study using nationwide databases in Taiwan, including the National Health Insurance Research Database (NHIRD), Taiwan Cancer Registry (TCR), and Death Registry from 2010 to 2019. A total of 3,284 patients with newly diagnosed esophageal cancer who received both nCCRT and surgery were included, of whom 453 had DM. The primary outcome was pCR, and the secondary outcome was OS. Multivariate logistic regression and Cox proportional hazard models were applied to evaluate associations, with subgroup analyses by age, sex, BMI, and lifestyle factors.ResultsThe overall pCR rate was 37.3%, with no significant difference between DM and non-DM groups (aOR=1.17, 95% CI: 0.94–1.44). Similarly, the adjusted hazard ratio for all-cause mortality was not statistically significant (aHR=1.087, 95% CI: 0.954–1.238). Subgroup analyses revealed heterogeneity: patients under 60 with DM had higher pCR (aOR=1.34), while drinkers with DM had lower pCR (aOR=0.50). Among patients achieving pCR, those with DM had higher mortality, though statistical significance was not reached after adjustment.ConclusionsDM did not significantly impact treatment response or survival in esophageal cancer patients undergoing nCCRT and surgery. Diabetes should not preclude aggressive treatment. Personalized treatment planning and integrated care for comorbidities may enhance cancer outcomes and healthcare equity.　　In conclusion, DM was not associated with worse treatment response or survival following nCCRT in esophageal cancer. Diabetes should not be a contraindication for aggressive therapy. Integrated comorbidity care and individualized prediction models are essential for optimizing outcomes.