Cancer Management and Research (Mar 2022)
Survival Risk Analysis of Small Cell Lung Cancer Patients with Pre-Existing Type 2 Diabetes Mellitus: A Single-Center Retrospective Cohort Study
Abstract
Jing Ding,1 Xudong Li,1 Jun Ge,1 Yuanqian Gong,1 Ya Zhou,1 Juan Xiao,1 Qin Yang,2 Jing Chen,1 Mian Mao3 1Department of Medical Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China; 2Department of Oncology, Bazhong Central Hospital, Bazhong, Sichuan, People’s Republic of China; 3Department of Pharmacy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of ChinaCorrespondence: Mian Mao, Tel/Fax +86-28-85420311, Email [email protected]: We aimed to investigate the clinicopathological characteristics and survival risk factors in small cell lung cancer (SCLC) patients with preexisting type 2 diabetes mellitus (preDM).Patients and Methods: All patients with SCLC admitted to our hospital between January 2013 and August 2018 were followed up until August 2020 and retrospectively analyzed. Clinical characteristics of SCLC patients with and without preDM were extracted. Cox proportional hazards models were conducted to identify potential independent prognostic factors.Results: Of 628 eligible individuals, 88 individuals had preDM. preDM was independently significantly associated with distant metastasis in all SCLC patients (p =0.016, OR=1.80, 95% CI 1.11– 2.91), while preDM did not affect the outcome of SCLC patients (p=0.803, HR=1.04, 95% CI 0.79– 1.36) by multivariate analysis. In the preDM group, the median overall survival (OS) was shorter in the insulin group than in the non insulin group (13.93 months versus 21.77 months, p=0.024). Multivariate analysis identified that insulin treatment was an independent unfavorable factor associated with OS (p =0.009, HR=2.10, 95% CI 1.19– 3.64). In addition, poorer performance status (PS) and liver metastasis were also independent unfavorable prognostic factors (all p< 0.01), while thoracic therapy significantly improved OS and decreased mortality risk in diabetic patients with SCLC (p< 0.05).Conclusion: preDM may promote distant metastasis of SCLC while it is insulin therapy and not preDM which adversely affects the prognosis of SCLC patients. These findings indicate that enhancing blood glucose control and reducing insulin analog use may be essential to the improvement of the long-term survival of the diabetic population with SCLC.Keywords: type 2 diabetes mellitus, small cell lung cancer, distant metastasis, insulin, overall survival
