Diabetes mellitus: A significant co-morbidity in the setting of lung cancer?

Iman Washington; Junzo P Chino; Lawrence B Marks; Thomas A D'Amico; Mark F Berry; Neal E Ready; Kristin A Higgins; David S Yoo; Chris R Kelsey

doi:10.1111/j.1759-7714.2012.00162.x

Diabetes mellitus: A significant co-morbidity in the setting of lung cancer?

Thorac Cancer. 2013 May;4(2):123-130. doi: 10.1111/j.1759-7714.2012.00162.x.

Authors

Iman Washington¹, Junzo P Chino¹, Lawrence B Marks¹, Thomas A D'Amico¹, Mark F Berry¹, Neal E Ready¹, Kristin A Higgins¹, David S Yoo¹, Chris R Kelsey¹

Affiliation

¹ Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA.

PMID: 28920196
DOI: 10.1111/j.1759-7714.2012.00162.x

Abstract

Background: To evaluate the effect of diabetes mellitus (DM) on clinical outcomes in patients managed surgically for non-small cell lung cancer (NSCLC).

Methods: Patients who underwent surgery for pathological I-IIIA NSCLC at Duke University from 1995-2005 were analyzed. Postoperative mortality was defined as any death occurring within 30 days of resection or during the initial hospitalization after surgery. Disease recurrence at the surgical margin, ipsilateral hilum, and/or mediastinum was considered a local/regional recurrence (LRR). Survival and LRR rates were estimated using the Kaplan-Meier method and compared using a log rank test. A multivariate regression analysis assessed the association between candidate factors, including DM, and disease recurrence and survival.

Results: Of 957 patients, DM was present in 122 (13%). DM was associated with an increased risk of postoperative mortality (7.4% vs. 3.2%, P= 0.04). However, the proportion of patients undergoing sublobar resections, mediastinal lymph node dissection, and receiving adjuvant chemotherapy, was no different among patients with or without DM. Five-year LRR rates were 27% in patients with DM, versus 21% in patients without DM (P= 0.23). Survival at five years was 43% for patients with DM, and 47% for patients without DM (P= 0.10). On multivariate analysis, DM was not independently associated with a higher risk of LRR (hazard ratio [HR] 1.33, P= 0.34), distant recurrence (HR 0.86, P= 0.58), or overall survival (HR 1.08, P= 0.63).

Conclusions: Although a higher risk of postoperative mortality was noted in patients with DM, a detriment in local or distant disease control or overall survival was not observed.

Keywords: Lung cancer; diabetes mellitus; hyperglycemia; local recurrence; non-small cell lung cancer; postoperative mortality.