| Background and ObjectiveLung cancer is the most common malignancy and the leading cause of cancer-related death worldwide.Diabetes mellitus(DM)is the most common endocrine disease,most of which are type 2 diabetes mellitus(T2DM).Epidemiological data show that T2 DM is a risk factor for a variety of tumor incidence and prognosis.However,the current research on the relationship between T2 DM and the prognosis of lung cancer is relatively few,and the conclusions are contradictory.We conducted a prognostic analysis of two groups of patients,one of the groups included 52 patients with stage IV lung cancer with T2 DM who received first-line platnum-based doublets chemotherapy and the other group of 63 patients with stage IV lung cancer but without T2 DM who received first-line platnum-based doublets chemotherapy.The aim of this study was to investigate the prognostic significance of T2 DM on patients with advanced lung cancer who received first-line platnum-based doublets chemotherapy.Methods:Through retrieving the medical records management system of Second Military Medical University Affiliated Changhai Hospital,we collected the patients with stage IV lung cancer with T2 DM who received first-line platnum-based doublets chemotherapy in department of Respiratory of Second Military Medical University Affiliated Changhai Hospital from January 2011 to December 2015 as DM group.And at the same time to 1: 1 ratio randomly collected the patients of stage IV lung cancer but without T2 DM who received first-line platnum-based doublets chemotherapy in department of Respiratory of Second Military Medical University Affiliated Changhai Hospital as control group.We recorded the general clinical characteristics of the patients such as age,gender,smoking history,whether other comorbidity and pathology at the time when lung cancer was diagnosed.Patients were followed up for progression free survival(PFS)and overall survival(OS)through hospitalization records,outpatient records,telephone consultation or email and mail correspondence.Chi-square test and T test were used to compare the differences of general clinical features between patients of the two groups.Univariate survival curve comparison ananlysis(Kaplan-Meier method)was used to compare PFS and OS between the two groups.Multivariate survival analysis(Cox regression analysis)was used to evaluate the effect of T2 DM on PFS and OS in patients with lung cancer after adjusting for confounders such as gender,age,smoking history,other comorbidity and pathological types.0Results:During the 5 years,a total of 88 patients with stage IV lung cancer with T2 DM who received first-line platnum-based doublets chemotherapy in department of Respiratory of Second Military Medical University Affiliated Changhai Hospital were collected and other 88 patients with stage IV lung cancer without T2 DM who received first-line platnum-based doublets chemotherapy in department of Respiratory of Second Military Medical University Affiliated Changhai Hospital during the same period were collected at the same time to 1: 1 ratio randomly.According to the inclusion criterias,a total of 115 patients were finally included in the study,including 52 patients in DM group and 63 patients in control group.The results of the comparison of general clinical features showed that the patients of DM group were older than the patients of control group,with an average age of 64 ± 7 years old vs 61 ± 8 years old(P = 0.009).The patients of DM group had higher ratio of male,smoking history and combined with other chronic diseases than those in the control group,the results of comparison were 38/52 vs 32/63(P=0.015)、25/52 vs 18/63(P=0.031)、30/52 vs 21/63(P=0.009),respectively.The pathological types are divided into two categories: non small cell lung cancer(NSCLC)and small cell lung cancer(SCLC).There was no significant difference in the pathological types between the two groups,SCLC / NSCLC was 5/47 vs 3/60(P = 0.422).The Univariate survival curve comparison ananlysis showed that the PFS was 13 months(95% CI 9-17 months)VS 8 months(95% CI 6-9 months)in the control group and the DM group(P = 0.135),PFS in the control group was longer than that in the DM group,but the difference was not statistically significant.While the OS of patients in the control group were significantly longer than patients of DM group,the mean OS was 36 months(95% CI 28-43 months)vs 18 months(95% CI 15-22 months),(P <0.001).Multivariate survival analysis showed that the effect of T2 DM on PFS was(HR= 0.719,95% CI: 0.451-0.145;P=0.165)and OS was(HR=0.539;95% CI: 0.334-0.870;P = 0.011).The effect of other chronic diseases other than T2 DM on PFS and OS of patients were(HR = 1.179;95% CI: 0.736-1.890;P = 0.493)and(HR = 1.756;95% CI: 1.080-2.856;P = 0.023),respectively.Conclusion:The overall survival of patients with advanced lung cancer with T2 DM who received first-line platnum-based doublets chemotherapy was significantly shorter than those without T2 DM.T2DM is an independent risk factor for the long-term survival of these patients.However,T2 DM had no significant effect on the disease progression of these patients.In addition,combined with other chronic diseases other than T2 DM is also an independent and significant risk factor for long-term survival of patients with advanced lung cancer who received first-line platnum-based doublets chemotherapy.Therefore,the treatment of patients with advanced lung cancer is a patient-centered,long-term comprehensive health management with the goal of maintaining and promoting overall patient health. |
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