Impact of Hyperglycemia on Outcomes among Patients Receiving Neoadjuvant Chemotherapy for Bulky Early Stage Cervical Cancer

Abstract

BackgroundThe impact of hyperglycemia on survival of patients undergoing neoadjuvant chemotherapy (NACT) for bulky early stage cervical cancer (BESCC) has not been explored.MethodRecords of patients who received NACT and radical hysterectomy in our institution between January 2005 and June 2010 were reviewed.ResultsIn total, 347 patients were included. The median follow-up time was 37 months (range: 4–65). Patients with hyperglycemia (fasting blood glucose ≥ 100 mg/dl) had shorter recurrence-free survival (RFS) (univariate hazard ratio [HR] = 1.95, 95% confidence interval [CI] [1.16, 3.28], P = 0.010) and cancer-specific survival (CSS) (univariate HR = 2.24, 95% CI [1.33, 3.78], P = 0.002) compared with those with euglycemia (fasting blood glucose <100 mg/dl). In multivariate analysis, positive surgical margins, parametrium invasion, node metastasis, hyperglycemia and complete response to NACT independently predicted recurrence and cancer-specific death. To further validate the prognostic value of hyperglycemia, we conducted a subgroup analysis based on patient baseline characteristics and prognostic effect of hyperglycemia remained significant in all subgroups. On multivariable logistic regression analysis, euglycemia before NACT, squamous cell tumor and pre-treatment squamous cell carcinoma antigen levels < 3.5 ng/ml were identified as independent predictors of complete response after NACT.ConclusionsFBG ≥100 mg/dl is a negative prognostic predictor for cervical cancer patients receiving NACT for BESCC. Patients with hyperglycemia are less likely to achieve complete response after NACT. Our findings underscore the clinical utility of hyperglycemia screening of for cervical cancer patients.

The added value of fasting blood glucose to serum squamous cell carcinoma antigen for predicting oncological outcomes in cervical cancer patients receiving neoadjuvant chemotherapy followed by radical hysterectomy

“…The prognostic significance of hyperglycemia in cervical cancer patients with advanced disease has been reported in the literature . We have also previously reported that LACC patients with hyperglycemia prior to NACT have a decreased likelihood of achieving CR compared with those with euglycemia . These findings were confirmed by the current study.…”

“…15,[18][19][20] For LACC patients, we previously reported that hyperglycemia before NACT is independently associated with a decreased likelihood of CR. 15 However, no data have supported that combining pretreatment SCCA and FBG levels improves the prediction of CR following NACT or refines the prognostic stratification of LACC patients. Therefore, we designed a retrospective cohort study to investigate the complementary role of FBG to SCCA in cervical cancer patients receiving NACT and radical hysterectomy for locally advanced disease.…”

“…There is a growing body of evidence that cancer patients with hyperglycemia have poor responses to chemotherapy . For cervical cancer patients, previous studies have revealed that an elevated level of fasting blood glucose (FBG) is a negative prognostic factor . For LACC patients, we previously reported that hyperglycemia before NACT is independently associated with a decreased likelihood of CR .…”

“…Therefore, it is necessary to identify additional markers that could complement SCCA. There is a growing body of evidence that cancer patients with hyperglycemia have poor responses to chemotherapy . For cervical cancer patients, previous studies have revealed that an elevated level of fasting blood glucose (FBG) is a negative prognostic factor .…”

“…[14][15][16][17][18] For cervical cancer patients, previous studies have revealed that an elevated level of fasting blood glucose (FBG) is a negative prognostic factor. 15,[18][19][20] For LACC patients, we previously reported that hyperglycemia before NACT is independently associated with a decreased likelihood of CR. 15 However, no data have supported that combining pretreatment SCCA and FBG levels improves the prediction of CR following NACT or refines the prognostic stratification of LACC patients.…”