Debata Ayumi, Yoshida Koichi, Ujifuku Kenta, Yasui Haruna, Kamada Kensaku, Niino Daisuke, Matsuo Takayuki
Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki - Japan.
Department of Pathology, Nagasaki University, Nagasaki - Japan.
Tumori. 2017 May 12;103(3):272-278. doi: 10.5301/tj.5000590. Epub 2016 Dec 29.
Primary central nervous system lymphoma (PCNSL) is a type of non-Hodgkin lymphoma (NHL), and it has been postulated that metabolic disorder may contribute to NHL etiology. We retrospectively investigated the prognostic significance of hyperglycemia in patients with PCNSL. We evaluated glucose transporter type 1 (GLUT1) expression by immunohistochemistry and analyzed its association with hyperglycemia and survival.
The medical and neuroradiologic records of 50 patients with PCNSL at our institution over the past 15 years were analyzed. Patients were divided into 3 groups based on mean fasting plasma glucose (FPG) levels: normal (<110 mg/dL), prediabetes (110-125 mg/dL), and diabetes (≥126 mg/dL). We defined prediabetes and diabetes groups as hyperglycemia.
Forty-four percent of patients were in the prediabetes and diabetes groups. One-year survival rates were 73%, 66%, and 43% in normal, prediabetes, and diabetes groups, respectively. Univariate analysis revealed that high age, female sex, poor performance status, high mean FPG, and monotherapy were associated with shorter survival. Multivariable Cox regression analyses showed that high mean FPG and monotherapy were significant predictors of shorter survival (p = 0.036 and p = 0.000, respectively). The GLUT1 immunohistopathologic staining was performed in 34 cases, 20 of which (58%) showed variable levels of GLUT1 expression at the cell membrane and/or cytoplasm. Prediabetes and diabetes groups had a higher percentage of GLUT1-positive cells compared with the normal group (p = 0.015).
These findings indicate that hyperglycemia is associated with poor survival. The putative biological mechanism might involve differential GLUT1 expression between hyperglycemic and normal states in patients with PCNSL.
原发性中枢神经系统淋巴瘤（PCNSL）是一种非霍奇金淋巴瘤（NHL），据推测代谢紊乱可能与NHL的病因有关。我们回顾性研究了高血糖对PCNSL患者预后的意义。我们通过免疫组织化学评估了葡萄糖转运蛋白1（GLUT1）的表达，并分析了其与高血糖和生存的关系。
分析了我院过去15年中50例PCNSL患者的医学和神经放射学记录。根据平均空腹血糖（FPG）水平将患者分为3组：正常（<110mg/dL）、糖尿病前期（110-125mg/dL）和糖尿病（≥126mg/dL）。我们将糖尿病前期和糖尿病组定义为高血糖组。
44%的患者属于糖尿病前期和糖尿病组。正常组、糖尿病前期组和糖尿病组的1年生存率分别为73%、66%和43%。单因素分析显示，高龄、女性、较差的体能状态、较高的平均FPG和单一疗法与较短的生存期相关。多变量Cox回归分析表明，较高的平均FPG和单一疗法是生存期较短的显著预测因素（分别为p = 0.036和p = 0.000）。对34例患者进行了GLUT1免疫病理染色，其中20例（58%）在细胞膜和/或细胞质中显示出不同水平的GLUT1表达。与正常组相比，糖尿病前期和糖尿病组GLUT1阳性细胞的百分比更高（p = 0.015）。
这些发现表明高血糖与较差的生存率相关。推测的生物学机制可能涉及PCNSL患者高血糖状态与正常状态之间GLUT1表达的差异。
