Hyperglycaemia and Survival in Solid Tumours: A Systematic Review and Meta-analysis

R Barua; A J Templeton; B Seruga; A Ocana; E Amir; J-L Ethier

doi:10.1016/j.clon.2018.01.003

Hyperglycaemia and Survival in Solid Tumours: A Systematic Review and Meta-analysis

Clin Oncol (R Coll Radiol). 2018 Apr;30(4):215-224. doi: 10.1016/j.clon.2018.01.003. Epub 2018 Feb 12.

Authors

R Barua¹, A J Templeton², B Seruga³, A Ocana⁴, E Amir⁵, J-L Ethier⁶

Affiliations

¹ Department of Medicine, University of Toronto, Toronto, Canada.
² Department of Medical Oncology, St. Claraspital Basel and Faculty of Medicine, University of Basel, Basel, Switzerland.
³ Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
⁴ Albacete University Hospital, Castilla La Mancha University, Albacete, Spain.
⁵ Department of Medicine, University of Toronto, Toronto, Canada; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada.
⁶ Department of Medical Oncology and Hematology, Kingston General Hospital, Queen's University, Kingston, Canada. Electronic address: .ethierjl@kgh.kari.net.

PMID: 29395413
DOI: 10.1016/j.clon.2018.01.003

Abstract

Aims: Diabetes is associated with adverse cancer outcomes. However, the effect of hyperglycaemia in non-diabetic cancer patients is unclear.

Materials and methods: A systematic search of electronic databases identified publications exploring the effect of hyperglycaemia on overall survival, disease-free survival (DFS) or progression-free survival (PFS). Data from studies reporting a hazard ratio and 95% confidence interval and/or a P-value were pooled in a meta-analysis using generic inverse-variance and random effects modelling. Subgroup analyses were conducted based on method of hyperglycaemia measurement (HbA1c, other) and stage (early, advanced, mixed). Meta-regression was performed to evaluate the influence of clinical characteristics including baseline diabetes status on the hazard ratio for overall survival.

Results: Twelve studies comprising a total of 9872 patients were included. All studies reported hazard ratios for overall survival. Three studies reported DFS; two reported PFS outcomes. Definitions of hyperglycaemia and cut-offs varied between studies. Hyperglycaemia was associated with worse overall survival (hazard ratio 2.05, 95% confidence interval 1.67-2.51; P < 0.001) and DFS (hazard ratio 1.98, 95% confidence interval 1.20-3.27; P = 0.007), but did not affect PFS (hazard ratio 1.08, 95% confidence interval 0.72-1.62; P = 0.71). The association with worse overall survival was maintained in subgroups based on method of hyperglycaemia measurement (subgroup difference P = 0.46) and stage (P = 0.14). Meta-regression showed a significantly greater magnitude of association between hyperglycaemia and decreased overall survival in studies with higher proportions of women and diabetic patients.

Conclusions: Hyperglycaemia is associated with adverse overall survival and DFS in patients with cancer. The therapeutic role of glycaemic control in cancer patients warrants further investigation.

Keywords: Cancer; Diabetes; Hyperglycaemia; Meta-analysis; Survival.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Disease-Free Survival
Female
Humans
Hyperglycemia / complications*
Hyperglycemia / mortality
Neoplasms / blood
Neoplasms / complications*
Neoplasms / mortality*
Prognosis
Proportional Hazards Models