Fasting Blood Glucose Level in Locally Advanced Non-Small Cell Lung Cancer: a New Prognostic Factor?

Abstract

Hyperglycemia may lead to proliferation, invasion, apoptosis inhibition, migration, and eventually metastasis of cancer cells by several mechanisms. In this study, the effect of hyperglycemia on overall survival (OS), disease-free survival (DFS), and locoregional recurrence (LRR) was investigated in NSCLC. One stage IIIA-IIIB NSCLC patient treated with chemoradiotherapy between 2010 and 2015 was enrolled. Fasting blood glucose (FBG) levels were recorded in pre-treatment, treatment, and post-treatment periods. Median age was 54 years (51-62). Fifty-two patients had squamous cell carcinoma (SCC); 19 had adenocarcinoma. Median follow-up was 19 (11-30), median survival was 19 (13-24), and DFS was 9 (7-11) months. Diabetic patients had shorter survival than non-diabetics 12 (95%CI, 10-14) vs. 25 months (95%CI,18-32), p = 0.005. Number of patients with LRR was also higher in diabetics compared to non-diabetics (8/12 vs. 11/37, p = 0.039). OS was shorter in patients with hyperglycemic-FBG and diabetic-FBG levels in pre-treatment period (log-rank p = 0.03 and 0.023, respectively). Diabetic-FBG level in pre-treatment period was found to be the only independent risk factor for survival. In subgroup analysis, these differences were apparent in SCC (log-rank p = 0.009 for hyperglicemic, log-rank p = 0.017 for diabetic-FBG). LRR was 68% in patients with diabetic-FBG, 36.5% in patients with non-diabetic-FBG in post-treatment period (p = 0.015). Patients with LRR had significantly higher median FBG value in post-treatment period compared to non-relapsing patients, 138 mg/dL (119-228) and 111 mg/dL (99-164), respectively (p = 0.022). The patients with hyperglycemic and diabetic-FBG levels in pre-treatment period had shorter survival compared to normoglycemic ones. The patients with diabetic-FBG level in post-treatment period had higher LRR, and relapsing patients had higher FBG levels in post-treatment period.

Hyperglycemia promotes Snail-induced epithelial–mesenchymal transition of gastric cancer via activating ENO1 expression

“…Despite recent developments in diagnosis and treatment, the prognosis of GC patients remains unfavorable mainly due to recurrence and distant metastasis [20]. Accumulating data and studies have shown that tumor patients with hyperglycemia, including those with GC, always have poor prognosis [9, 21–23]. Surprisingly, postoperative hyperglycemia was associated with poor outcomes even in non-diabetic patients undergoing elective gastric surgery for cancer [24].…”

<p>Fasting blood glucose levels and prognosis in patients with non-small-cell lung cancer: a prospective cohort study in China</p>

“…On the contrary, diabetes also impedes cancer cell invasion through the basocellular membrane by diabetic microangiopathy via microvascular changes, resulting in decreased metastatic ability and improved prognosis 15. Thus far, only a few studies investigated the prognostic impact of fasting blood glucose (FBG) on NSCLC mortality and found that hyperglycemia may have significantly lower survival 16,17. However, blood glucose has not been observed in a further stratification.…”

Association between insulin resistance, metabolic syndrome and its components and lung cancer: a systematic review and meta-analysis

“…However, their study excluded individuals with FPG ≥ 7.1 mmol/l, a slight difference from our criteria. In addition, either too high (> 110 mg/dl) [ 58 ] or too low (< 91 mg/dl) FBG reduced survival in patients with NSCLC [ 59 ].…”