Front Oncol:血糖控制对晚期非小细胞肺癌(NSCLC)伴有糖尿病患者的生存影响

2021-11-16 yd2015 MedSci原创

研究表明,血糖水平受损对晚期NSCLC患者的生存有负面影响,而适当的血糖控制(HbA1c≤6.6%)可改善OS。

糖尿病(DM)是癌症患者常见的基础病之一。其可能影响肿瘤治疗策略和预后。非小细胞肺癌(Non-small cell lung cancer, NSCLC)占肺癌的大多数。越来越多的人开始关注NSCLCDM并存的结局和治疗。然而,NSCLCDM的预后和生物学相互作用仍然很大程度上未知。近期,Frontiers in Oncology杂志上发表了来自上海交通大学上海胸科医院团队的一项研究结果,旨在评估晚期非小细胞肺癌(NSCLC)伴有糖尿病患者的预后,并评估最佳的血糖控制是否能改善总生存(OS)

1279例晚期NSCLC患者,包括300(23.5%)既往有糖尿病。分析糖化血红蛋白A1C (HbA1c)水平与OS之间的关系。分析确定最佳糖化血红蛋白临界点。Kaplan-Meier法进行生存分析,并按糖尿病状况和糖化血红蛋白进行分组比较。在调整基线特征后,采用多变量Cox比例风险回归分析确定OS的预后因素。

1279例晚期NSCLC中,有300(23.5%)既往有糖尿病,中位HbA1c6.0%(范围:4.5-10.7%)与非糖尿病患者相比,糖尿病患者更可能有更大的BMICVD进一步将DM患者按HbA1c水平分为3等级(:4.5-5.7,中:5.8-6.1,高:6.2-10.7),高水平患者多为老年、男性、吸烟史、非腺癌,BMICVDEGFR均较高整个队列的中位随访时间为19.66个月(四分位数范围:11.01-27.98)糖尿病患者的OS与非糖尿病患者相似[中位数(95% CI): 22.85 (20.05-26.73) vs 22.22(20.35-24.76)个月,P=0.950]。

多因素Cox回归分析也显示,糖尿病状态(HR: 0.929, 95% CI: 0.788-1.096, P=0.384)并不是OS独立预后因素,而EGFR野生型(HR: 2.053, 95% CI: 1.650- 2.555, P<0.001)、吸烟史(HR:1.404, 95% CI: 1.204- 1.638, P<0.001)、IV期(HR:2.402, 95% CI:2.058-2.802, P < 0.001)和一线使用EGFR-TKIs治疗(HR:0.732, 95% CI: 0.580-0.923, P=0.009)是OS的独立预后因素。

糖尿病患者中,根据HbA1c水平分层分析发现,高HbA1c水平患者的OS明显较低、中水平患者的差(高水平 vs 低水平:p=0.002;高水平 vs 中水平:p=0.006 )。然而,中水平患者很低水平患者的OS没有统计学差异(中水平 vs 低水平:p=0.66)高、中、低水平患者OS分别为31.04 (23.57-37.12), 26.73 (22.26-31.43)和17.69(13.45-20.88)个月。

通过RCS来揭示HbA1cOS之间的持续关系。研究表明,无论基线特征调整与否,HbA1c水平与OS之间都存在非线性正相关(P<0.01)。

          RCS来揭示HbA1cOS之间的持续关系

X-tile分析显示HbA1c的最佳临界值为6.6,这表明OS的预后差异最显著。HbA1c≤6.6%患者的OS较HbA1c>6.6%患者明显延长(P<0.001)。在调整基线特征后的多因素分析中,结果仍然有显著统计学差异(HbA1c>6.6糖尿病患者vs HbA1c≤6.6糖尿病患者:HR=1.593, 95% CI: 1.113- 2.280, P=0.011)。

            X-tile分析显示HbA1c的最佳临界值为6.6

          预后相关多因素分析

糖尿病控制良好定义为HbA1c≤6.6%。所有患者被分为三组(非糖尿病组、糖尿病合并HbA1c≤6.6%组和糖尿病合并HbA1c>6.6%组),分析最佳血糖控制的生存获益。非糖尿病组、糖尿病合并HbA1c≤6.6%组和糖尿病合并HbA1c>6.6%组患者的中位OS (95% CI)分别为22.22(20.01-24.43)、25.28(21.79- 28.77)和15.45(7.57-23.33)个月。糖尿病控制良好(HbA1c≤6.6%)患者的OS跟非糖尿病患者类似 (HR (95% CI): 0.90 (0.76-1.08), P = 0.273)。而糖尿病合并HbA1c>6.6%组患者的OS较非糖尿病患者(HR (95% CI): 1.70 (1.24 - 2.34), P = 0.001)和糖尿病控制良好(HbA1c≤6.6%)患者[HR (95% CI): 1.88(1.33-2.67),P= 0.001)差。亚组分析显示,与非糖尿病患者相比,HbA1c控制良好的糖尿病患者所有亚组均有生存获益。

                HbA1c不同分层对预后影响

综上,研究表明,血糖水平受损对晚期NSCLC患者的生存有负面影响,而适当的血糖控制(HbA1c≤6.6%)可改善OS。

原始出处:

Qian J, Wang W, Wang L, Lu J, Zhang L, Zhang B, Wang S, Nie W, Zhang Y, Lou Y and Han B (2021) The Survival Benefit for Optimal Glycemic Control in Advanced Non-Small Cell Lung Cancer Patients With Preexisting Diabetes Mellitus. Front. Oncol. 11:745150. doi: 10.3389/fonc.2021.745150

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    2022-09-03 minlingfeng
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  4. 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attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00ed5697300, createdName=ms6000001024089719, createdTime=Sun Nov 21 16:10:17 CST 2021, time=2021-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1072251, encodeId=34ce10e2251bb, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=51122087651, createdName=谖伶, createdTime=Sat Nov 20 16:01:29 CST 2021, time=2021-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1072199, encodeId=711b10e2199b8, content=、∴学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=dbbc5723650, createdName=ms9000000080461052, createdTime=Sat Nov 20 13:01:39 CST 2021, time=2021-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273055, encodeId=522f12e305569, content=<a href='/topic/show?id=2f468983351' target=_blank style='color:#2F92EE;'>#血糖控制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89833, encryptionId=2f468983351, topicName=血糖控制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ef84111, createdName=whlxd, createdTime=Thu Nov 18 14:21:31 CST 2021, time=2021-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475175, encodeId=44ea14e5175dd, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, 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createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/10/16/7ebdfa3e0c90cc17d719f3557ba4d278.jpg, createdBy=d2ea2211959, createdName=帅哥的名字就是长, createdTime=Wed Nov 17 22:37:36 CST 2021, time=2021-11-17, status=1, ipAttribution=)]
    2021-11-21 ms6000001024089719

    很不错

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2060044, encodeId=f751206004483, content=<a href='/topic/show?id=2cc599381bd' target=_blank style='color:#2F92EE;'>#非小细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99381, encryptionId=2cc599381bd, topicName=非小细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e07307, createdName=lingaifan, createdTime=Mon Aug 01 10:21:31 CST 2022, time=2022-08-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866354, encodeId=91ae186635475, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, 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time=2021-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273055, encodeId=522f12e305569, content=<a href='/topic/show?id=2f468983351' target=_blank style='color:#2F92EE;'>#血糖控制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89833, encryptionId=2f468983351, topicName=血糖控制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ef84111, createdName=whlxd, createdTime=Thu Nov 18 14:21:31 CST 2021, time=2021-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475175, encodeId=44ea14e5175dd, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, 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createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/10/16/7ebdfa3e0c90cc17d719f3557ba4d278.jpg, createdBy=d2ea2211959, createdName=帅哥的名字就是长, createdTime=Wed Nov 17 22:37:36 CST 2021, time=2021-11-17, status=1, ipAttribution=)]
    2021-11-20 谖伶

    学习

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2060044, encodeId=f751206004483, content=<a href='/topic/show?id=2cc599381bd' target=_blank style='color:#2F92EE;'>#非小细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99381, encryptionId=2cc599381bd, topicName=非小细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e07307, createdName=lingaifan, createdTime=Mon Aug 01 10:21:31 CST 2022, time=2022-08-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866354, encodeId=91ae186635475, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, 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time=2021-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273055, encodeId=522f12e305569, content=<a href='/topic/show?id=2f468983351' target=_blank style='color:#2F92EE;'>#血糖控制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89833, encryptionId=2f468983351, topicName=血糖控制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ef84111, createdName=whlxd, createdTime=Thu Nov 18 14:21:31 CST 2021, time=2021-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475175, encodeId=44ea14e5175dd, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, 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createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/10/16/7ebdfa3e0c90cc17d719f3557ba4d278.jpg, createdBy=d2ea2211959, createdName=帅哥的名字就是长, createdTime=Wed Nov 17 22:37:36 CST 2021, time=2021-11-17, status=1, ipAttribution=)]
    2021-11-20 ms9000000080461052

    、∴学了

    0

  7. 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attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00ed5697300, createdName=ms6000001024089719, createdTime=Sun Nov 21 16:10:17 CST 2021, time=2021-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1072251, encodeId=34ce10e2251bb, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=51122087651, createdName=谖伶, createdTime=Sat Nov 20 16:01:29 CST 2021, time=2021-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1072199, encodeId=711b10e2199b8, content=、∴学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=dbbc5723650, createdName=ms9000000080461052, createdTime=Sat Nov 20 13:01:39 CST 2021, time=2021-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273055, encodeId=522f12e305569, content=<a href='/topic/show?id=2f468983351' target=_blank style='color:#2F92EE;'>#血糖控制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89833, encryptionId=2f468983351, topicName=血糖控制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ef84111, createdName=whlxd, createdTime=Thu Nov 18 14:21:31 CST 2021, time=2021-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475175, encodeId=44ea14e5175dd, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, 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createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/10/16/7ebdfa3e0c90cc17d719f3557ba4d278.jpg, createdBy=d2ea2211959, createdName=帅哥的名字就是长, createdTime=Wed Nov 17 22:37:36 CST 2021, time=2021-11-17, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=2060044, encodeId=f751206004483, content=<a href='/topic/show?id=2cc599381bd' target=_blank style='color:#2F92EE;'>#非小细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99381, encryptionId=2cc599381bd, topicName=非小细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e07307, createdName=lingaifan, createdTime=Mon Aug 01 10:21:31 CST 2022, time=2022-08-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866354, encodeId=91ae186635475, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, 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time=2021-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273055, encodeId=522f12e305569, content=<a href='/topic/show?id=2f468983351' target=_blank style='color:#2F92EE;'>#血糖控制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89833, encryptionId=2f468983351, topicName=血糖控制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ef84111, createdName=whlxd, createdTime=Thu Nov 18 14:21:31 CST 2021, time=2021-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475175, encodeId=44ea14e5175dd, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, 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createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/10/16/7ebdfa3e0c90cc17d719f3557ba4d278.jpg, createdBy=d2ea2211959, createdName=帅哥的名字就是长, createdTime=Wed Nov 17 22:37:36 CST 2021, time=2021-11-17, status=1, ipAttribution=)]
  9. [GetPortalCommentsPageByObjectIdResponse(id=2060044, encodeId=f751206004483, content=<a href='/topic/show?id=2cc599381bd' target=_blank style='color:#2F92EE;'>#非小细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99381, encryptionId=2cc599381bd, topicName=非小细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e07307, createdName=lingaifan, createdTime=Mon Aug 01 10:21:31 CST 2022, time=2022-08-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866354, encodeId=91ae186635475, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, 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time=2021-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273055, encodeId=522f12e305569, content=<a href='/topic/show?id=2f468983351' target=_blank style='color:#2F92EE;'>#血糖控制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89833, encryptionId=2f468983351, topicName=血糖控制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ef84111, createdName=whlxd, createdTime=Thu Nov 18 14:21:31 CST 2021, time=2021-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475175, encodeId=44ea14e5175dd, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, 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createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/10/16/7ebdfa3e0c90cc17d719f3557ba4d278.jpg, createdBy=d2ea2211959, createdName=帅哥的名字就是长, createdTime=Wed Nov 17 22:37:36 CST 2021, time=2021-11-17, status=1, ipAttribution=)]
    2021-11-17 JZ Yang

    感谢分享

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=2060044, encodeId=f751206004483, content=<a href='/topic/show?id=2cc599381bd' target=_blank style='color:#2F92EE;'>#非小细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99381, encryptionId=2cc599381bd, topicName=非小细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e07307, createdName=lingaifan, createdTime=Mon Aug 01 10:21:31 CST 2022, time=2022-08-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866354, encodeId=91ae186635475, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, 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time=2021-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273055, encodeId=522f12e305569, content=<a href='/topic/show?id=2f468983351' target=_blank style='color:#2F92EE;'>#血糖控制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89833, encryptionId=2f468983351, topicName=血糖控制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ef84111, createdName=whlxd, createdTime=Thu Nov 18 14:21:31 CST 2021, time=2021-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475175, encodeId=44ea14e5175dd, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, 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createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/10/16/7ebdfa3e0c90cc17d719f3557ba4d278.jpg, createdBy=d2ea2211959, createdName=帅哥的名字就是长, createdTime=Wed Nov 17 22:37:36 CST 2021, time=2021-11-17, status=1, ipAttribution=)]
    2021-11-17 帅哥的名字就是长

    学到新知识了

    0