Results published in Journal of Clinical Oncology point to why such patients who are also overweight and physically inactive are more likely to die.

Researchers have found that in people who have undergone surgery for colorectal cancer, the levels of two insulin-related proteins in their blood before diagnosis predicted their chances of dying from the cancer or other conditions. Patients with high prediagnosis levels of insulin-like growth factor binding protein-1 (IGFBP-1) were less than half as likely to succumb to the disease. Those with high levels of C-peptide, on the other hand, were nearly twice as likely to die.

The team notes that these findings help explain why people with surgically removed colorectal cancer and who are overweight, physically inactive, and follow a Western-pattern diet may have an increased risk of dying of the disease or other causes.

Using data from two long-term studies, the investigators examined prediagnosis levels of four insulin-related proteins in 373 people who later developed stage I-III colorectal cancer. All four proteins are known to increase or decrease in response to lifestyle factors such as poor nutrition, physical inactivity, and obesity.

Levels of two of the proteins were unrelated to colon cancer recurrence or death. The connection between IGFBP-1, C-peptide, and mortality, however, was strong. Patients with the highest levels of IGFBP-1 had a 56% lower risk of death during the study period and a 57% lower risk of dying from colorectal cancer. Researchers speculate that the protein may exert a protective effect by blocking other growth factors that contribute to colon cancer cell proliferation.

High levels of C-peptide, by contrast, doubled the risk of overall death in people with cancer but were not significantly associated with death from colorectal cancer itself. The investigators speculate that this may be because of an even stronger link between high insulin levels and other potentially fatal diseases such as heart disease and stroke or because C-peptide is not as accurate a measure of insulin-related hormonal changes as other proteins.

The results of the study were published online in the December 8 Journal of Clinical Oncology. The article’s authors conduct research at the Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Massachusetts General Hospital, Harvard School of Public Health, Jewish General Hospital, and McGill University.

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