Prognostic value of Diabetes in Patients with Nasopharyngeal Carcinoma Treated with Intensity-Modulated Radiation Therapy

Abstract

The prognostic value of diabetes remains unknown in nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). We retrospectively reviewed medical records of 1489 patients with non-metastatic, histologically-proven NPC treated using IMRT. 81/1489 (5.4%) patients were diabetic, 168/1489 (11.3%) were prediabetic, and 1240/1489 (83.3%) were normoglycemic. The 4-year disease-free survival (DFS), overall survival (OS), loco-regional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS) rates were 77.1% vs. 82.4% (P = 0.358), 85.8% vs. 91.0% (P = 0.123), 90.9% vs. 91.7% (P = 0.884), and 85.5% vs. 89.2% (P = 0.445) for diabetic vs. normoglycemic patients, and 82.4% vs. 82.4% (P = 0.993), 88.7% vs. 91.0% (P = 0.285), 90.6% vs. 91.7% (P = 0.832) and 91.5% vs. 89.2% (P = 0.594) for preidabetic vs. normoglycemic patients. Multivariate analysis did not established diabetes as poor prognostic factors in NPC patients treated with IMRT (P = 0.332 for DFS, P = 0.944 for OS, P = 0.977 for LRRFS, P = 0.157 for DMFS), however, triglycerides and low density lipoprotein cholesterol were independent prognostic factors. In conclusion, diabetes does not appear to be a prognostic factor in NPC patients treated with IMRT, and attention should be paid to hyperglycemia-associated hyperlipaemia.

Impact of diabetes mellitus on the risk and survival of nasopharyngeal carcinoma: a meta-analysis

“…After further full-test review, 56 articles were excluded and nine studies were ultimately included in the present meta-analysis, 15 – 23 of which four studies reported association between DM and NPC risk ( Table 1 ), 15 – 18 and another five studies reported association between DM and NPC outcome ( Table 2 ). 19 – 23 …”

“…Five studies reported the influence of DM on outcomes among patients with NPC. 19 – 23 The main characteristics of these five included studies are listed in Table 2 . The included studies were published between 2006 and 2017.…”

“…Three studies reported the median follow-up period, 20 , 21 , 23 with a range between 34.6 and 66.0 months. Four studies adopted multivariate analysis method, 19 – 22 but only one study used a matched design to select control patients. 20 DM was identified in the cohorts using blood glucose test results validated by medical records in all five studies.…”

Type 2 Diabetic Mellitus Is a Risk Factor for Nasopharyngeal Carcinoma: A 1:2 Matched Case–Control Study

“…According to OuYang et al [ 6 ], the diabetic and prediabetic NPC patients had similar survival to normoglycemic NPC patients. Recently, Hao Peng et al [ 7 ] also found that diabetes had no prognostic impact on NPC patients treated using IMRT. However, in the study of Liu et al [ 5 ], the diabetes group had a worse DFS than the non-diabetes group.…”

“…In a study by Liu et al [ 5 ], DFS in patients with diabetes was poorer than in those without diabetes. While OuYang et al [ 6 ] and Hao Peng et al [ 7 ] found that diabetic and prediabetic NPC patients had similar survival to normoglycemic NPC patients. All these previous studies were cohort studies, which may not get more reliable results inevitably caused by confounding factors like gender, age, T stage, N stage, clinical stage, radiotherapy, chemotherapy.…”