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Master Thesis

Intérêt du scanner thoraco-abdomino-pelvien pour le diagnostic de cancer chez les patients diabétiques qui maigrissent

Abstract : Introduction: unexpected weight loss is a common, nonspecific manifestation of many illnesses and can be due to cancer. In the general population, only 1.4% cancers are diagnosed during the 6 months after weight loss, which may not merit specific investigations. Cancers of the pancreas, liver, kidney and lung are detectable by a CT-scanner, and more frequent among subjects with diabetes, but we do not know how many cases can be detected in poorly controlled, weight-loosing, patients with diabetes. Research Design And Methods: we identified from our hospital registry all patients admitted in our diabetologic unit from 2010 to 2019, who had a CT-Scanner during their hospitalization. From the 461 identified subjects, we excluded cases with specific indications: signs or symptoms outside weight loss and already known tumors. 275 patients hospitalized for uncontrolled diabetes had a CT-Scanner because of unexpected weight loss. They were interviewed, examined, urinary and had blood and urinary samples. All the subjects had a contrast-injected CT-scanner of the chest, abdomen and pelvis. CT scans were classified as positive if they led to the diagnosis of a cancer. The results of the continuous variables were expressed as mean±SD or median (IQR). The categorical variables were presented as numbers (percentages). The subjects with cancer diagnostic were compared to the others by ANOVA or non parametric tests for continuous variables, and by Chi-2 for categorial variables. A binary logistic regression analysis was performed to analyze which parameters related to the diagnosis of cancer, adjusted for age and gender. A value of p<0.05 was considered as significant. Results: we analysis 275 patients, mainly men, 58.7±12.9 years old, with 5 (0-13) years durations of diabetes, poorly controlled: mean HbA1c at 10.7±2.9% (93±25 mmol/mol). Most of them (62.2%) had chronic diabetic complications: 38.1% had a neuropathy, 32.1% had a diabetic kidney disease, 16.0% had a diabetic retinopathy and 20.1% had a macroangiopathy. Their BMI was 26.8±6.0kg/m2 at the inclusion and the maximal BMI during their life had been 32.7±7.3kg/m2. The CT-scanner led to the diagnosis of cancer in 18 patients (6.5%): 8 pancreas, 5 lung, 3 liver and 2 kidney. These patients did not have a greater recent weight loss than the others, however they had lost more from their maximal weight: -21.7kg±12.4 vs -15.1kg±11.2 (p=0.02): 41.2% had lost more than 20 kg (vs 22.5% for others, p=0.081). The relations between cancer and weight loss (HR: 1.043, 95%CI: 1.009-1.0079) or more than -20kg weight loss (HR: 3.343, 95%CI: 1.080-10.347) were significant after adjustments for age, gender and HbA1c, which were lower in patient with cancer: 9.4±2.0% (79±17mmol/mol) vs 10.7±2.9% (93±25mmol/mol) (p=0.047). The HbA1c were negatively related to the recent weight loss (B = -0.305, p<0.001), and not to the long term weight loss. The durations of diabetes did not differ between cancer cases and others, but only one cancer was detected among the 93 subjects with a recent onset (< 1 year) diabetes. Conclusion: Among 275 patients admitted for uncontrolled diabetes and weight loss, the CT-scanner of the chest, abdomen and pelvis allowed the diagnosis of 18 cancers: 6.5%. The patients with cancer had a greater long-term weight loss adjusted for age, gender and HbA1c.
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Submitted on : Friday, June 25, 2021 - 10:03:58 AM
Last modification on : Friday, July 9, 2021 - 3:48:02 AM
Long-term archiving on: : Sunday, September 26, 2021 - 6:20:35 PM


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Marie-Amelie Barbet-Massin. Intérêt du scanner thoraco-abdomino-pelvien pour le diagnostic de cancer chez les patients diabétiques qui maigrissent. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03270692⟩



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