Hemoglobin A1c level is a prognostic factor for locoregional recurrence in stage III non‐small cell lung cancer patients treated with radiotherapy

Abstract

Background The level of hemoglobin A1c (HbA1c) might be associated with the severity of tumor hypoxia in patients with cancer. Here, we evaluated the association between the level of HbA1c and survival outcome in stage III non‐small cell lung cancer patients treated with radical radiotherapy. Methods We retrospectively analysed the clinical data of 104 patients with lung cancer treated with radiotherapy. The HbA1c levels of all patients were checked 1 week before the start of radiotherapy. Survival outcomes were analysed according to the HbA1c level. Results The 1‐, 2‐, and 3‐year locoregional recurrence‐free survival rates were 88.3%, 68.8%, and 63.0%, respectively, in the patient group with HbA1c levels ≤6% and 75.5%, 54.4%, and 41.8%, respectively, in the patient group with HbA1c levels >6% (p = 0.015). The HbA1c level remained a significant prognostic factor for locoregional recurrence‐free survival on multivariable analysis (hazard ratio = 2.014, 95% confidence interval = 1.088–3.726, p = 0.026). Conclusions Pretreatment HbA1c level is a significant prognostic factor for locoregional recurrence‐free survival in patients with stage III non‐small cell lung cancer treated with radical radiotherapy. Routine monitoring of pretreatment HbA1c levels and aggressive glycemic control may be considered to prevent the development of locoregional recurrence in these patients.

Chronic hyperglycemia is an adverse prognostic factor for locoregional recurrence‐free survival in small cell lung cancer patients treated with radical radiotherapy

“…In our previous study, chronic hyperglycemia was significantly associated with locoregional recurrence-free survival, but not with distant metastasis-free survival. 5 The results of the current study were similar to those of our previous study (p = 0.010 for locoregional recurrence-free survival and p = 0.603 for distant metastasis-free survival in multivariable analysis). Because tumor hypoxia, which is aggravated in a chronic hyperglycemic state, exerts an adverse effect on radiation response, locoregional recurrence-free survival might be mainly influenced by chronic hyperglycemia rather than distant metastasis-free survival.…”

“…The 1-, 2-, and 3-year locoregional recurrence-free survival rates were 90.9, 86.1, and 86.1%, respectively, in the patient group with low hemoglobin A1c levels and 54.2, 27.1, and 20.3%, respectively, in the patient group with high hemoglobin A1c levels (p < 0.001 in univariate and p = 0.010 in multivariate analysis) recurrence, with a relative risk of 2.014 in patients with stage III non-small cell lung cancer treated with radical RT. 5 This and our previous studies provide valuable information regarding the interaction between plasma glucose levels and the efficacy of RT in patients with cancer. Plasma glucose and HbA1c levels are easily derived and cost-effective blood parameters.…”

“…In our previous study, we reported the impact of plasma glucose levels on the efficacy of RT in patients with non-small cell lung cancer. 5 Although prospective studies with large sample sizes should be conducted to confirm F I G U R E 2 Distant metastasisfree survival curve according to hemoglobin levels. The 1-, 2-, and 3-year distant metastasis-free survival rates were 51.7, 30.4, and 30.4%, respectively, in the patient group with low hemoglobin levels and 82.9, 63.6 and 63.6%, respectively, in the patient group with high hemoglobin levels (p = 0.011 in univariate and p = 0.049 in multivariate analysis) our results, we believe that plasma glucose levels can be effectively used to predict treatment outcomes in patients with cancer treated with RT.…”

“…In that study, the patient group with hemoglobin A1c (HbA1c) >6% had a higher risk of locoregional recurrence than the group with HbA1c ≤6%, with a relative risk of 2.014. 5 We assumed that we could obtain such results in our previous study because HbA1c reflects the mean plasma glucose level for the previous 3 months, and hypoxic tumors are resistant to RT. [6][7][8] In this study, we evaluated the association between plasma glucose levels in terms of HbA1c and locoregional recurrence-free survival in patients with limited-stage small cell lung cancer treated with radical RT.…”

“…In our previous study, we evaluated the association between blood glucose levels and survival outcomes in patients with stage III non‐small cell lung cancer who were treated with radical radiotherapy (RT). In that study, the patient group with hemoglobin A1c (HbA1c) >6% had a higher risk of locoregional recurrence than the group with HbA1c ≤6%, with a relative risk of 2.014 5 . We assumed that we could obtain such results in our previous study because HbA1c reflects the mean plasma glucose level for the previous 3 months, and hypoxic tumors are resistant to RT 6–8 …”