The Survival Benefit for Optimal Glycemic Control in Advanced Non-Small Cell Lung Cancer Patients With Preexisting Diabetes Mellitus

Overview

Journal Front Oncol

Specialty Oncology

Date 2021 Dec 6

PMID 34868942

Citations 1

Authors

Jie Qian

Weimin Wang

Lin Wang

Jun Lu

Lele Zhang

Bo Zhang

Shuyuan Wang

Wei Nie

Yanwei Zhang

Yuqing Lou

Baohui Han

Affiliations

Soon will be listed here.

Abstract

Background: Diabetes mellitus (DM) is a frequent comorbidity in patients with cancer. This study aimed to evaluate the prognosis of advanced non-small cell lung cancer (NSCLC) patients with DM and to assess whether an optimal glycemic control improves overall survival (OS).

Methods: A total of 1279 advanced NSCLC patients including 300 (23.5%) with preexisting DM were retrospectively reviewed. The continuous relationship between glycated hemoglobin A1C (HbA1c) level and OS was analyzed by restricted cubic spline (RCS) function. Optimal HbA1c cut-off point was determined using X-tile analysis. Survival was analyzed with the Kaplan-Meier method and compared among groups stratified by diabetes status and HbA1c. Multivariable Cox proportional hazards regression analysis was employed to identify prognostic factors for OS after adjusting for baseline characteristics.

Results: DM and non-DM patients had similar OS (median (95% CI): 22.85 (20.05-26.73) 22.22 (20.35-24.76) months, P=0.950). The multivariate Cox regression analyses showed that DM status was not a prognostic factor for OS (HR: 0.952, 95% CI: 0.808-1.122, P=0.559). However, there existed a non-linear but generally positive relationship between the elevated HbA1c level and increased risk of overall mortality. HbA1c > 6.6% was a negative prognostic factor for OS (HR: 1.593, 95% CI: 1.113-2.280, P=0.011). The median OS (95% CI) for nondiabetic patients, DM patients with HbA1c ≤6.6% and those with HbA1c > 6.6% was 22.22 (20.01-24.43), 25.28 (21.79-28.77) and 15.45 (7.57-23.33) months, respectively. Well-controlled DM patients had a comparable crude OS (HR (95% CI): 0.90 (0.76-1.08), P=0.273] compared to nondiabetic patients while patients with HbA1c>6.6% had a worse crude OS than patients without DM (HR (95% CI): 1.70 (1.24-2.34), P=0.001]. The survival benefit of good HbA1c control was prominent in all subgroups.

Conclusion: Impaired glycemic level negatively affects survival for patients with advanced NSCLC while proper glycemic control with HbA1c ≤6.6% improves the OS.

Citing Articles

Disease burden of lung cancer attributable to metabolic and behavioral risks in China and globally from 1990 to 2021.

Li L, Zhang X, Jiang A, Guo X, Li G, Zhang M BMC Public Health. 2025; 25(1):911.

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Effects of Diabetes on Inflammatory Status and Prognosis in Cancer Patients.

Liu X, Zheng K, Ji W, Zhang W, Li Y, Liu M Front Nutr. 2022; 9:792577.

PMID: 35308284 PMC: 8931397. DOI: 10.3389/fnut.2022.792577.

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