Background Diabetes is related with increased cancer mortality across multiple cancer types. Its role in lung cancer mortality is still unclear. We aim to determine the prognostic value of fasting plasma glucose (FPG) and diabetes mellitus in patients with locally advanced non-small cell lung cancer (NSCLC) treated with concurrent chemoradiotherapy. Methods One-hundred seventy patients with stage III NSCLC received definitive concurrent chemoradiotherapy from 2010 to 2014. Clinico-pathological data and clinical outcome was retrospectively registered. Fifty-six patients (33%), met criteria for type 2 diabetes mellitus (T2DM) at baseline. The prognostic value of FPG and other clinical variables was assessed. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method and Cox proportional models and log-rank test were used. Results With a median follow-up of 36 months, median PFS was 8.0 months and median OS was 15.0 months in patients with FPG ≥7 mmol/L compared to 20 months (HR 1.13; 95% CI 1.07–1.19, p < 0.001) and 31 months (HR 1.09; 95% CI 1.04–1.15; p < 0.001) respectively, for patients with FPG < 7 mmol/L. In the multivariate analysis of the entire cohort adjusted by platinum compound and comorbidities, high levels of FPG as a continuous variable (HR 1.14; 95% CI 1.07–1.21; p < 0.001), the presence of comorbidity (HR 1.72; 95% CI 1.12–2.63; p = 0.012), and treatment with carboplatin (HR 1.95; 95% CI 1.26–2.99; p = 0.002) were independent predictors for shorter OS. In additional multivariate models considering non-diabetic patients as a reference group, diabetic patients with poor metabolic control (HbA1c > 8.5%) (HR 4.53; 95% CI 2.21–9.30; p < 0.001) and those receiving insulin (HR 3.22; 95% CI 1.90–5.46 p < 0.001) had significantly independent worse OS. Conclusion Baseline FPG level is an independent predictor of survival in our cohort of patients with locally advanced NSCLC treated with concurrent chemoradiotherapy. Studies in larger cohorts of patients are warranted to confirm this relevant association. Electronic supplementary material The online version of this article (10.1186/s12885-019-5370-5) contains supplementary material, which is available to authorized users.

Double pigtail for preventing ascending cholangitis after endoscopic ultrasonographyguided choledochoduodenostomy with lumen-apposing metal stentThe present case is a good example of how the new biliary lumen-apposing metal stent (LAMS), specially designed for endoscopic ultrasonography (EUS)-guided biliary drainage, can be totally occluded by food impaction. This can be prevented by placing a pigtail stent within the LAMS.A patient with unresectable pancreatic cancer causing obstructive jaundice after a failed endoscopic retrograde cholangiopancreatography (ERCP) underwent EUS-guided choledochoduodenostomy from the duodenal bulb, using the Hot AXIOS System (Xlumena Inc., Mountain View, CA, USA). A specific biliary diabolo-shaped lumen-apposing metal stent (inner diameter, 6 mm; length 8 mm) was successfully placed. After initial clinical improvement, the patient again had cholangitis and relapse of the obstructive jaundice. Computed tomography (CT) scan revealed a well-positioned stent and air inside the common bile duct (CBD). Upper endoscopy confirmed the suspicion of an occluded biliary LAMS. Cholangiogram was carried out revealing a quantity of food inside the CBD (Fig. 1). Cleaning of the stent was achieved using mechanical devices (sphincterotome, balloon extractor, grasping forceps) and energic Serum saline physiological (SSF) irrigation. After redirection of the guidewire using an ERCP catheter, a 10-Fr double-pigtail stent was inserted through the LAMS in order to avoid occlusion of its lumen with solid food (Fig. 2; Video S1).Although there are sufficient data on the use of LAMS in pancreatic collections, to date, only a few case reports have been published regarding the use of this new dedicated biliary self-expanding metal stent (SEMS) in EUS-guided biliary drainage. 1-5 It appears very attractive to use routinely after a failed ERCP, but despite its potential advantages, we should be cautious until more data are available. The potential risk of ascending cholangitis after biliary transmural drainage using biliary LAMS must be kept in mind. Placing a double-pigtail plastic stent within this stent (to avoid self-occlusion) could be helpful.

Disclosure declarations: M.C.U.C. has a patent for Breast Cancer Classifier: US Patent No. 9,631,239 with royalties paid, is an advisory member of Veracyte and receives research funding from NanoString Technologies. MD receives honoraria from Myriad Genetics and is a consultant and advisory board member of GTx, Radius Health, Orion Pharma, Lilly, Agile and Astrazeneca, has received funding from Pfizer (Inst) and Radius Health (Inst) and has been payed expenses from Pfizer and Myriad Genetics. HT reports a grant from Bayer. JMB reports grants from Cancer Research UK, during the conduct of the study; grants from Medivation; grants and non-financial support from AstraZeneca, Merck Sharp & Dohme, Puma Biotechnology, Clovis Oncology, Pfizer, Janssen-Cilag, Novartis, and Roche, outside the submitted work. The rest of authors declare no potential conflicts of interests. Statement of translational relevance:Our study shows that neoadjuvant treatment with short and longer-term aromatase inhibitors (AI) in primary estrogen receptor (ER+) positive breast cancer (BC) exerts comparable impact on changes in intrinsic subtypes between baseline and surgery. However, neoadjuvant AI treatment beyond 2 weeks leads moreResearch.