化疗期间血液系统和实体肿瘤的高血糖与毒性增加相关。

Hyperglycemia during chemotherapy for hematologic and solid tumors is correlated with increased toxicity.

机构信息

Istituto Oncologico Veneto, IOV--IRCCS Padova, Italy.

出版信息

Am J Clin Oncol. 2011 Jun;34(3):292-6. doi: 10.1097/COC.0b013e3181e1d0c0.

DOI:10.1097/COC.0b013e3181e1d0c0

PMID:20622641

Abstract

BACKGROUND

Few data are available concerning how glycemic control can affect outcomes in cancer patients treated with chemotherapy.

METHODS

Charts of non-Hodgkin lymphoma (NHL) and prostate cancer (PC) patients treated at Moffitt Cancer Center between January 1999 and September 2006 were reviewed, and patients who received cyclophosphamide, doxoruicin, vincristine, prednisone, rituximab or Docetaxel plus steroids were eligible. Demographics, vitals, comorbidity, laboratory parameters including baseline and average glucose level during chemotherapy, G4 hematological toxicity (HemT), and G3-G4 non-hematological toxicity (NHemT), progression, and death dates were recorded.

RESULTS

A total of 349 patients were eligible (NHL/PC: 162/187). G4 HemT was experienced by 76 (47%) NHL and 9 (5%) PC patients. Seventy-nine NHL and 90 PC patients had G3-G4 NHemT. The most frequent NHemT were as follows: neuropathy (25.3%), fever (non-neutropenic, 18.9%), fatigue (15.2%), for NHL; and fatigue (22.1%), thromboembolic events (11.6%), and diarrhea (9.3%) for PC. For NHL patients, G3-G4 NHemT was associated with baseline hyperglycemia (P = 0.0384, Wilcoxon Rank-Sum test) as well as with average glycemia during chemotherapy (P = 0.0048), whereas there was no significant correlation for HemT. For PC patients, a positive correlation was found between baseline hyperglycemia and G4 HemT (P = 0.0241), while univariate correlations between average glycemia during chemotherapy and G4 HemT and between both baseline and average glycemia with NHemT were not significant, multivariate correlation between average glycemia during chemotherapy and overall severe toxicity was significant at 0.05 level.

CONCLUSIONS

In NHL patients, hyperglycemia correlates with NHemT, and a similar although less clear pattern is suggested in PC patients. Prospective studies are needed to assess whether a better glycemic control during chemotherapy can improve toxicity and outcomes.

摘要

背景

关于化疗治疗的癌症患者的血糖控制如何影响结果的数据很少。

方法

回顾了 1999 年 1 月至 2006 年 9 月期间在 Moffitt 癌症中心治疗的非霍奇金淋巴瘤（NHL）和前列腺癌（PC）患者的病历，并将接受环磷酰胺、多柔比星、长春新碱、泼尼松、利妥昔单抗或多西他赛加类固醇治疗的患者纳入研究。记录了人口统计学资料、生命体征、合并症、实验室参数（包括化疗期间的基线和平均血糖水平）、4 级血液学毒性（HemT）和 3-4 级非血液学毒性（NHemT）、进展和死亡日期。

结果

共有 349 名患者符合条件（NHL/PC：162/187）。76 名（47%）NHL 患者和 9 名（5%）PC 患者出现 4 级 HemT。79 名 NHL 患者和 90 名 PC 患者出现 3-4 级 NHemT。最常见的 NHemT 如下：神经病变（25.3%）、发热（非中性粒细胞减少性，18.9%）、疲劳（15.2%），用于 NHL；疲劳（22.1%）、血栓栓塞事件（11.6%）和腹泻（9.3%），用于 PC。对于 NHL 患者，3-4 级 NHemT 与基线高血糖（P=0.0384，Wilcoxon 秩和检验）以及化疗期间平均血糖（P=0.0048）相关，而与 HemT 无显著相关性。对于 PC 患者，基线高血糖与 4 级 HemT 之间存在正相关（P=0.0241），而化疗期间平均血糖与 4 级 HemT 之间以及基线和平均血糖与 NHemT 之间的单变量相关性不显著，化疗期间平均血糖与整体严重毒性之间的多变量相关性在 0.05 水平具有显著性。