Elsevier

Gynecologic Oncology

Volume 116, Issue 3, March 2010, Pages 459-463
Gynecologic Oncology

Glucose as a prognostic factor in non-diabetic women with locally advanced cervical cancer (IIB–IVA)

https://doi.org/10.1016/j.ygyno.2009.11.016Get rights and content

Abstract

Objective

The aim of this study was to evaluate the association between pretreatment random plasma glucose levels and cancer prognosis in non-diabetic women with locally advanced cervical cancer treated with CCRT (concurrent chemoradiation) or RT (radiation therapy) only.

Methods

We investigated the non-fasting plasma glucose levels checked during the initial work up before treatment in 134 non-diabetic patients with locally advanced cervical cancer. Based on the survival time and the progression-free interval (PFI) recorded in the electronic medical records Cox proportional hazard regression models were used to estimate the hazard ratio (HR) for overall survival and PFI according to the various level of glucose and a cut-off level (< 102 mg/dL and ≥ 102 mg/dL), adjusting for clinical covariates.

Results

A shorter overall survival and PFI was observed in the group with higher glucose levels (HR, 1.03; p = 0.002, HR, 1.02; p = 0.001, respectively) and more than 102 mg/dL, by univariate analyses (HR, 3.21; p = 0.012, HR, 2.20; p = 0.006, respectively). Multivariate analysis, adjusting for clinical FIGO stage, performance status, treatment type (CCRT vs. RT) and chemotherapeutic regimen types showed that patients with higher glucose levels or more than ≥ 102 mg/dL had shorter overall survival times (HR, 1.02; p = 0.015, HR, 2.54; p = 0.049, respectively) and PFI (HR, 1.02; p = 0.003, HR, 1.88; p = 0.031, respectively).

Conclusion

This investigation provides evidence supporting the prognostic value of glucose levels in non-diabetic women with locally advanced cervical cancer treated with radiation therapy and/or concurrent chemotherapy; high glucose levels were associated with a greater risk for recurrence and mortality in these patients.

Introduction

Cervical cancer is the second most common cancer in women worldwide and the third most common cause of cancer mortality. The burden of disease is much higher in developing countries, where the incidence is five times than that in developed countries and the mortality is 10 times higher [1], [2]. Despite early detection of cervical cancer by advances in screening, a significant number of women still present with locally advanced disease. Currently, concurrent chemotherapy plus radiotherapy (CCRT; concurrent chemoradiation) can be considered the treatment for locally advanced cervical cancer. Nevertheless, around 30% of patients with locally advanced cervical carcinoma will die due to local tumor relapse or the development of distant metastases [3].

Evidence from clinical studies has indicated that diabetic patients have higher mortality and recurrence rates after diagnosis and treatment for cancer [4], [5]. One study showed that male adults with diabetes had a mortality risk from breast, colon, pancreatic and liver cancer that was greater than in patients without diabetes, regardless of the BMI, and other potentially confounding factors [6]. Recently, it was reported that glucose levels, in diabetic and non-diabetic patients with ovarian cancers, were associated with prognosis; there was a positive correlation between higher glucose levels and a shorter disease-free interval and a decrease in the disease specific survival [7]. Moreover translational research has suggested that the glucose transporter protein 1 (GLUT 1) in cervical cancer patients was overexpressed and overexpression was related to a higher tumor grade [8].

The aim of this study was to evaluate the association of the pretreatment random plasma glucose level with cancer prognosis in non-diabetic women with locally advanced cervical cancer treated with CCRT or RT focusing on the clinical correlation of glucose and cancer outcome.

Section snippets

Patients

With IRB (Institutional Review Board) approval, we retrospectively evaluated 246 patients with cervical cancer (IIB-IVA) by reviewing the electronic medical record (EMR) of women treated with CCRT or RT at the Samsung Medical Center, Sungkyunkwan University School of Medicine. The clinical information included: clinical stage, histological type, DM status, radiotherapy data, chemotherapeutic agents, performance status and response after treatment from August 1994 to December 2007. We excluded

Results

Among the 134 patients, the mean follow-up time was 38.0 ± 26.7 months. There were 62.7 percent of patients that were diagnosed with clinical FIGO stage IIB, and 88.8% had the squamous cell type. There were 64.2% of patients that had CCRT; among these patients 58.1% had combination chemotherapy with 5-FU plus cisplatin. The median pretreatment glucose level was 102 mg/dL (63–175 mg/dL) (Table 1). A cut-off value of 102 mg/dL for the glucose levels was used to determine the survival rate after

Discussion

The aim of the current study was to determine whether blood glucose levels were associated with prognosis in non-diabetic women with locally advanced cervical cancer treated with radiation therapy and/or concurrent chemotherapy. The patients with pretreatment glucose levels more than 102 mg/dL had decreased disease-specific overall survival time and PFI after controlling for other clinical factors including clinical stage, performance status (ECOG), type of primary treatment and

Conflict of interest statement

The authors declare that there are no conflicts of interest.

References (24)

  • D.M. Lamkin et al.

    Glucose as a prognostic factor in ovarian carcinoma

    Cancer

    (2009)
  • Diagnosis and classification of diabetes mellitus

    Diabetes Care

    (2009)
  • Cited by (0)

    1

    Co-first author.

    View full text