Prognostic Significance of Hyperglycemia in Patients with Brain Tumors: a Meta-Analysis

Liu, Hongwei; Liu, Zhixiong; Jiang, Bing; Ding, Xiaoyu; Huo, Lei; Wan, Xin; Liu, Jinfang; Xia, Zhenyun

doi:10.1007/s12035-015-9115-4

Cited by 12 publications

(10 citation statements)

References 35 publications

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“…Previous meta-analyses have shown a poor survival associated with diabetes in patients with cancer, [ 8 ] including prostate, [ 9 ] pancreatic, [ 10 ] breast, [ 43 ] cervical, [ 44 ] colorectal, [ 45 ] lung, [ 46 ] and brain [ 47 ] cancer. Although the exact mechanisms underpinning worse outcomes in cancer patients with comorbid diabetes are unknown, hyperglycaemia and hyperinsulinemia have been proposed as possible biological pathways due to their roles in stimulating tumour growth [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Glycosylated haemoglobin and prognosis in 10,536 people with cancer and pre-existing diabetes: a meta-analysis with dose-response analysis

et al. 2022

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Aims To assess whether glycaemic control is associated with prognosis in people with cancer and pre-existing diabetes. Methods In this pre-registered systematic review (PROSPERO: CRD42020223956), PubMed and Web of Science were searched on 25th Nov 2021 for studies investigating associations between glycosylated haemoglobin (HbA1c) and prognosis in people with diabetes and cancer. Summary relative risks (RRs) and 95% Confidence Intervals (CIs) for associations between poorly controlled HbA1c or per 1-unit HbA1c increment and cancer outcomes were estimated using a random-effects meta-analysis. We also investigated the impact of potential small-study effects using the trim-and-fill method and potential sources of heterogeneity using subgroup analyses. Results Fifteen eligible observational studies, reporting data on 10,536 patients with cancer and pre-existing diabetes, were included. Random-effects meta-analyses indicated that HbA1c ≥ 7% (53 mmol/mol) was associated with increased risks of: all-cause mortality (14 studies; RR: 1.14 [95% CI: 1.03–1.27]; p-value: 0.012), cancer-specific mortality (5; 1.68 [1.13–2.49]; p-value: 0.011) and cancer recurrence (8; 1.68 [1.18–2.38; p-value: 0.004]), with moderate to high heterogeneity. Dose-response meta-analyses indicated that 1-unit increment of HbA1c (%) was associated with increased risks of all-cause mortality (13 studies; 1.04 [1.01–1.08]; p-value: 0.016) and cancer-specific mortality (4; 1.11 [1.04–1.20]; p-value: 0.003). All RRs were attenuated in trim-and-fill analyses. Conclusions Our findings suggested that glycaemic control might be a modifiable risk factor for mortality and cancer recurrence in people with cancer and pre-existing diabetes. High-quality studies with a larger sample size are warranted to confirm these findings due to heterogeneity and potential small-study effects. In the interim, it makes clinical sense to recommend continued optimal glycaemic control.

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Section: Discussionmentioning

confidence: 99%

Glycosylated haemoglobin and prognosis in 10,536 people with cancer and pre-existing diabetes: a meta-analysis with dose-response analysis

et al. 2022

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“…The distress prevalence in patients with intracranial tumor is not higher than that in patients with lung cancer (61.6%) [ 27 ] or bone marrow transplant patients (43.0%) [ 28 ]. The possible reasons could be the quick disease progression of a malignant brain tumor or early interventions by some of the clinical practitioners [ 17 , 29 – 31 ]. Fatigue, pain, anxiety, and depression are among the most troubling symptom associated with the prevalence of distress in brain tumor patients which will result in a poorer overall survival and decreased health-related quality of life (HRQoL) [ 17 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Screening for distress in patients with primary brain tumor using distress thermometer: a systematic review and meta-analysis

et al. 2018

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BackgroundPatients with primary brain tumors are reported to have an elevated level of distress prevalence, due to the functional sequelae and the unfavorable prognosis, but the estimated prevalence of this disorder varies among studies. The Distress Thermometer (DT) is widely used distress screening tools to identify patients suffering from elevated psychosocial distress. The objective of this meta-analysis is to get a summarized estimate of distress prevalence in adult primary brain tumor patients screened by the DT instrument to identify distress in brain tumor patients.MethodWe searched studies published in PubMed, PsycINFO, and Cochrane library through August 2017 and checked related reviews and meta-analyses for eligible studies. Studies were eligible if they were published in the peer-reviewed literature and evaluated distress level by Distress Thermometer. The prevalence of distress symptoms in patients with the intracranial tumor was estimated by study-level characteristics using stratified meta-analysis. The prevalence of distress level or symptoms during the follow-up examination at different time points was detected by secondary analysis of the longitudinal studies included.ResultsTwelve studies including a total of 2145 brain tumor patients were included in this analysis. Eight used a cross-sectional design and four were longitudinal. The pooled prevalence of distress was 38.2% (95% confidence interval (CI) 28.7%–47.7%) for the overall sample. The pooled prevalence of distress DT ≥4 was 41.1% (642/1686, 95% CI 28.6%–53.5%) and the pooled prevalence of distress by DT ≥6 was 29.7% (137/459, 95% CI 19.5%–39.9%). The distress symptom did not decrease in follow-up studies (Relative Increase Ratio:1.02, 95% CI, (0.78, 1.35)). A huge heterogeneity in different studies was detected, and different screening scales were not compared.ConclusionThe high prevalence of distress becomes an enormous challenge for primary brain tumor patients. Routine screening and evaluation of distress in brain tumor patients may assist medical workers to develop proper interventions, which may lead to better quality of life and oncology management.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-3990-9) contains supplementary material, which is available to authorized users.

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“…This raises concern due to the poor outcomes that have been associated with hyperglycemia and outcomes in brain tumor patients. Liu et al [31] conducted a recent meta-analysis on 2,168 patients and found that hyperglycemia was significantly associated with decreased overall survival, and this was irrespective of the cause of hyperglycemia.…”

Section: Standard Of Practicementioning

confidence: 99%

“…Historically, between 70-100% of patients with brain metastases have received steroid treatment during adjuvant RT, and between 10-50% after completion of RT [32][33][34][35][36][37]. Additionally, dexamethasone appears to have been the steroid of choice for these patients, with a starting daily dose of around 16 mg, but highly dependent on the patient clinical status [31,35,38]. Currently, clinical practice guidelines for patients with brain metastases recommend starting these patients on 4-8 mg/day of dexamethasone in the case of mild symptoms related to mass effect and reserving the higher dose of 16 mg/day for patients with severe symptoms [1].…”

Section: Standard Of Practicementioning

confidence: 99%

Steroid utility, immunotherapy, and brain tumor management: an update on conflicting therapies

Goldman¹,

Lucke‐Wold

Martínez-Sosa

et al. 2022

Exploration of Targeted Anti-Tumor Therapy

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Steroid use is a widely accepted practice for both the treatment and prevention of tumor-induced edema, but there are many unknowns regarding their current clinical utility with modern anti-tumor therapies. This decreases edema and relieves the symptomatic mass effect. There are clearly understood benefits and commonly accepted complications of methylprednisolone (MP) use, but the topic is recently controversial. With immunotherapy advancing, a robust immune response is crucial for full therapeutic efficacy. The immunosuppression of MP may interfere with future and current therapeutics relying on the integrity of the patient’s immune system. This further emphasizes the need for alternative agents to effectively treat tumor-induced cerebral edema. This review highlights the current clinical utility of steroids to treat brain tumor-related edema and the underlying pathophysiology. It also reviews details regarding different steroid formulations and dosing. Research available regarding concurrent steroid use with immunotherapy is detailed next, followed by alternatives to steroids and barriers to their adoption. Finally, this paper discusses pre-clinical findings and emerging treatments aimed to augment or replace steroid use.

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Prognostic Significance of Hyperglycemia in Patients with Brain Tumors: a Meta-Analysis

Cited by 12 publications

References 35 publications

Glycosylated haemoglobin and prognosis in 10,536 people with cancer and pre-existing diabetes: a meta-analysis with dose-response analysis

Glycosylated haemoglobin and prognosis in 10,536 people with cancer and pre-existing diabetes: a meta-analysis with dose-response analysis

Screening for distress in patients with primary brain tumor using distress thermometer: a systematic review and meta-analysis

Steroid utility, immunotherapy, and brain tumor management: an update on conflicting therapies

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