Study On The Relationship Between The Risk Of Chemotherapy-induced Peripheral Neuropathy And Diabetes

Objective:To systematically evaluate the association between the risk of chemotherapy-induced peripheral neuropathy（CIPN）and diabetes mellitus.Clinical research was conducted to analyze the influencing factors of oxaliplatin-induced peripheral neuropathy（OXIPN）,and to further explore whether the risk of OXIPN is associated with diabetes.Methods:1.Meta-analysis:Embase,PubMed,Web of Science,CNKI and WanFang databases were searched for cohort and case-control studies about the relevance of the risk of CIPN and diabetes from inception to December 31,2017.The Newcastle-Ottawa scale（NOS）was used to evaluate the quality of these two types of studies and Stata11.0software was used to perform meta-analysis of the eligible studies.2.Clinical research:A retrospective analysis was performed on 268 patients with colorectal cancer treated with oxaliplatin.The basic information of patients,disease history,clinical treatment and adverse reactions after chemotherapy were collected and SPSS22.0 was used to perform the obtained clinical data.Influence factors of OXIPN were screened by single factor analysis using chi-square test,and logistic regression was used for multivariate analysis to find independent influence factors for OXIPN.Results:1.Meta-analysis:A total of 15 articles,16 studies,and 3541 patients were included.Meta-analysis showed that the risk of CIPN was higher in cancer patients with diabetes than in those without diabetes（OR=1.65,95%CI:1.33-2.05,p=0.000）.The difference was statistically significant.Subgroup analysis showed that the risk of CIPN was related to diabetes whether in Asian region（OR=1.65,95%CI:1.28-2.12,p=0.000）or non-Asian region（OR=1.65,95%CI:1.08-2.53,p=0.020）.The risk of taxane-induced peripheral neuropathy was significantly associated with diabetes（OR=1.72,95%CI:1.32-2.24,p=0.000）,while the risk of OXIPN was not obviously associated with diabetes（OR=1.31,95%CI:0.83-2.05,p=0.242）.2.Clinical research:Of 268 patients with colorectal cancer who received chemotherapy with oxaliplatin,61 had OXIPN during treatment,with an incidence of 22.76%.Among 268 patients included in the study,67had diabetes（25%of total）.Patients were divided into two groups according to whether they have diabetes.The incidence of OXIPN in diabetic patients was 34.33%,and the incidence of OXIPN in non-diabetics was 18.91%.The incidence of OXIPN in patients with diabetes was higher than that in patients without diabetes.The difference was statistically significant（p<0.05）.The other factors related to OXIPN were found by univariate analysis,including:drinking history（p<0.05）,oxaliplatin cumulative dose（p<0.05）and elevation of ALT（p<0.05）.Multivariate analysis showed the history of diabetes（OR=2.263,95%CI:1.153-4.441,p=0.018）,drinking history（OR=1.997,95%CI:1.004-3.974,p=0.049）,cumulative dose of oxaliplatin（OR₁=2.873,95%CI:1.235-6.685,p=0.014;OR₂=3.301,95%CI:1.237-8.814,p=0.017）and elevation of ALT（OR=2.341,95%CI:1.246-4.396,p=0.008）are independent influence factors of OXIPN.The history of diabetes,the history of drinking,increased cumulative dose of oxaliplatin,elevation of ALT during chemotherapy can increase the risk of OXIPN.Conclusions:1.The risk of CIPN is closely related to diabetes which increases the risk of CIPN.2.The risk of OXIPN is significantly associated with diabetes.Diabetes is an independent risk factor for OXIPN,suggesting that when patients with colorectal cancer are treated with oxaliplatin,if they have diabetes,doctors should pay close attention to the occurrence of adverse reactions,especially peripheral neuropathy and take active prevention and treatment measures.They should adjust the dose of chemotherapy drug according to clinical conditions to minimize the risk of peripheral neuropathy,in order to reduce the pain of patients as well as improve their quality of life.At the same time,our study also found that the risk of OXIPN is associated with drinking history,oxaliplatin cumulative dose and elevation of ALT.