Department of Radiooncology and Radiotherapy, University Medical Center, Langenbeckstrasse 1, 55131, Mainz, Germany,
Strahlenther Onkol. 2014 Oct;190(10):933-8. doi: 10.1007/s00066-014-0696-z. Epub 2014 Jun 18.
In comparison to normal brain tissue, glioblastomas exhibit significantly increased glucose uptake. Brain edema is a common complication during adjuvant chemoradiotherapy, leading to a requirement for glucocorticoid treatment. Glucocorticoid treatment frequently causes considerable deregulation of blood glucose levels. Therefore, episodes of hyperglycemia may contribute to radio- and/or chemoresistance.
This study comprises a retrospective analysis of the influence of hyperglycemic episodes (HEs) during adjuvant therapy on the overall survival of 106 glioblastoma multiforme patients.
The occurrence of one or more deregulated blood glucose value(s) > 10 mM is associated with a reduction in median overall survival from 16.7 to 8.8 months. A significantly poorer overall survival of patients with hyperglycemia could also be detected in subgroup analyses of patients with complete tumor resection and complete treatment according to the EORTC 22891/26891 trial protocol, as well as in a multivariate Cox proportional hazards analysis. A history of diabetes mellitus had no influence on prognosis.
Our data suggest that the observed negative impact of elevated blood glucose levels on overall survival may not solely be explained by the patients' poorer general condition; the elevated blood glucose concentration itself may play a pathogenetic role. This could be due to increased activity of antioxidant systems, elevated expression of DNA damage response proteins and protection of hypoxic tumor cells against apoptosis combined with hypoxia-mediated radioresistance.
A possible prognostic impact of elevated blood glucose levels during the period of adjuvant (chemo-) radiotherapy of glioblastoma should be evaluated in a prospective clinical trial.
与正常脑组织相比，胶质母细胞瘤表现出明显增加的葡萄糖摄取。脑水肿是辅助放化疗期间的常见并发症，导致需要糖皮质激素治疗。糖皮质激素治疗经常导致血糖水平的显著失调。因此，高血糖发作可能导致放射和/或化学耐药。
本研究回顾性分析了辅助治疗期间高血糖发作（HE）对 106 例多形性胶质母细胞瘤患者总生存期的影响。
一次或多次血糖值失控（血糖值>10mM）的发生与中位总生存期从 16.7 个月缩短至 8.8 个月相关。在完全肿瘤切除和根据 EORTC 22891/26891 试验方案进行完全治疗的患者亚组分析中，以及在多变量 Cox 比例风险分析中，也可以检测到伴有高血糖的患者总体生存率显著较差。糖尿病史对预后没有影响。
我们的数据表明，观察到的高血糖水平对总生存期的负面影响可能不仅仅是由患者较差的一般状况解释的；升高的血糖浓度本身可能发挥致病作用。这可能是由于抗氧化系统活性增加、DNA 损伤反应蛋白表达升高以及缺氧肿瘤细胞免受凋亡的保护与缺氧介导的放射耐药相结合所致。
在胶质母细胞瘤辅助（化疗）放疗期间升高的血糖水平可能对预后有影响，应在前瞻性临床试验中进行评估。
