Clinical Study Of The Effect Of Metformin On The Incidence And Prognosis Of Radiation Pneumonitis After IMRT In Patients With Stage Ⅲ NSCLC Complicated With Type 2 Diabetes Mellitus

Objective To observe the effect of metformin on the incidence,late-onset rate and 1-year overall survival(OS)of patients with stage III non-small cell lung cancer with type 2 diabetes after intensity modulated radiation therapy.Methods A retrospective study of patients with stage III non-small cell lung cancer and type2 diabetes admitted to our hospital from January 2015 to December 2017 was divided into metformin and insulin hypoglycemic treatment in 30 cases.Both groups received intensity modulation.Radiotherapy,chest enhancement CT or MRI,blood routine,urine routine,lung cancer tumor markers,glycosylated hemoglobin,fasting blood glucose before and after radiotherapy,and 1 year follow-up.Statistical analysis was performed using SPSS 22.0.The clinical and pathological factors of the two groups were statistically analyzed.Kaplan-Meier was used to evaluate and map the survival curve.Single factor and Logistic multivariate analysis were used to evaluate the incidence of radiation pneumonitis and the recent effective rate.And the effect of 1-year overall survival(OS),the defined test level was 0.05,P <0.05,the difference was statistically significant.Results 1.Comparison of general data showed gender,age,BMI,KPS score,smoking status,whether surgery,tumor location,pathological type,differentiation degree,TNM stage,blood glucose control,diabetes duration,hypoglycemic drugs The differences were not statistically significant,and there was no significant difference between the clinical data,which could be compared.2.For radiation pneumonitis,univariate analysis showed that the patient’s gender,age,BMI,KPS score,smoking status,whether surgery,tumor location,pathological type,differentiation,TNM staging,hypoglycemic drugs did not affect(P >0.05);Logistic multivariate analysis showed that poor glycemic control(HbA1c ≥ 7%)and long duration ofdiabetes(> 5 years)were risk factors for radiation pneumonitis(P<0.05);3.For the recent effective rate,the single factor analysis showed that the patient’s gender,age,BMI,KPS score,smoking status,whether surgery,tumor location,pathological type,differentiation,TNM staging and glycemic control did not affect(P>0.05);Logistic multivariate analysis showed that the long course of diabetes(>5 years)was a risk factor for poor recent efficiency(P<0.05),while hypoglycemic drugs had no significant effect on the recent effective rate;4 For 1-year overall survival(OS),the patient’s gender,age,BMI,KPS score,smoking status,whether surgery,tumor location,pathological type,differentiation,TNM stage,duration of diabetes,and There was no effect on blood glucose control(P>0.05).Logistic multivariate analysis showed that insulin was the risk factor for survival(P<0.05).The 1-year overall survival(OS)of metformin and insulin was found by survival curve.There was no significant statistical difference in the apparent curve separation(P>0.05).Conclusions 1.Metformin has no obvious protective effect after IMRT in patients with stage III NSCLC with diabetes.In contrast,insulin is a risk factor,there is no significant difference in the 1-year OS of the two,and the effective rate of radiation pneumonitis No significant impact occurred;2.Diabetes duration and glycemic control The risk factors for radiation pneumonitis after IMRT in patients with stage III NSCLC with diabetes;3.The duration of diabetes is a recent risk factor for IMRT in patients with stage III NSCLC with diabetes.