Adeberg Sebastian, Bernhardt Denise, Foerster Robert, Bostel Tilman, Koerber Stefan Alexander, Mohr Angela, Koelsche Christian, Rieken Stefan, Debus Juergen
a University Hospital of Heidelberg, Department of Radiation Oncology , Heidelberg , Germany.
b Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ) , Heidelberg , Germany.
Acta Oncol. 2016;55(2):201-7. doi: 10.3109/0284186X.2015.1043397. Epub 2015 May 20.
Metabolism in tumor cells depends mainly on glycolysis and thus hyperglycemia has been shown to influence tumor properties in various tumor entities. In this retrospective study we set out to determine if hyperglycemic serum levels during radiation therapy impact patient survival and progression patterns in primary glioblastoma (GBM).
We retrospectively analyzed glucose serum levels, survival and progression patterns on magnetic resonance imaging (MRI) in 262 GBM patients receiving radiation therapy. Hyperglycemia was classified as mild (> 180 mg/dL) or excessive (≥ 300 mg/dL), and isolated (one hyperglycemic event) or persistent (≥ 3 hyperglycemic events). The multivariate Cox proportional hazards ratio was used to assess the influence of cofactors on survival.
Persistent mild (HR = 2.23; p < 0.001) and excessive hyperglycemia (HR = 2.51; p < 0.001) were associated with a decrease in overall survival rates, even when considering the covariate corticosteroid therapy. Here metabolic imbalances did not affect the progression-free interval (p = 0.402), the occurrence of distant (p = 0.587) and multifocal progression (p = 0.445).
Our findings support the theory that hyperglycemia during radiation therapy in GBM patients is an unfavorable prognostic cofactor for survival and is detrimental to the survival rates independent of corticosteroid therapy. However, no significant effects of hyperglycemic metabolism on the progression-free interval and recurrence patterns were found.
肿瘤细胞的代谢主要依赖糖酵解，因此高血糖已被证明会影响多种肿瘤实体的肿瘤特性。在这项回顾性研究中，我们旨在确定放射治疗期间的高血糖血清水平是否会影响原发性胶质母细胞瘤（GBM）患者的生存及进展模式。
我们回顾性分析了262例接受放射治疗的GBM患者的血清葡萄糖水平、生存情况以及磁共振成像（MRI）上的进展模式。高血糖被分类为轻度（>180mg/dL）或重度（≥300mg/dL），以及孤立性（一次高血糖事件）或持续性（≥3次高血糖事件）。采用多变量Cox比例风险比来评估协变量对生存的影响。
即使考虑协变量皮质类固醇治疗，持续性轻度高血糖（HR = 2.23；p < 0.001）和重度高血糖（HR = 2.51；p < 0.001）也与总生存率降低相关。在此，代谢失衡并未影响无进展生存期（p = 0.402）、远处转移的发生（p = 0.587）和多灶性进展（p = 0.445）。
我们的研究结果支持以下理论，即GBM患者放射治疗期间的高血糖是生存的不良预后协变量，且独立于皮质类固醇治疗对生存率有害。然而，未发现高血糖代谢对无进展生存期和复发模式有显著影响。
