合并糖尿病及治疗过程中血糖升高对弥漫大B细胞淋巴瘤患者预后的影响

目的探讨弥漫大B细胞淋巴瘤(DLBCL)患者的临床特征和预后因素,评估合并糖尿病(DM)及治疗过程中发生血糖升高对DLBCL预后的影响。方法回顾性收集2009年1月1日至2019年12月31日天津医科大学肿瘤医院及中山大学肿瘤防治中心收治的481例初诊DLBCL患者的临床资料,重点关注其治疗前及治疗中的血糖水平,采用Cox回归风险模型进行单因素分析评估预后影响因素,采用Kaplan-Meier法绘制生存曲线分析血糖异常对DLBCL患者总生存(OS)、无进展生存(PFS)的影响。结果82例(17.0%)患者在诊断DLBCL前患DM,88例(18.3%)患者在DLBCL治疗过程中至少发生一次血糖升高。单因素分析显示,年龄、Ann-Arbor分期、IPI评分、是否合并DM与OS、PFS相关(P值均<0.05)。组间比较显示,合并DM组与治疗过程中血糖升高组的OS和PFS均较无血糖异常组差(OS:P值分别为0.001、0.003,PFS:P值均<0.001),合并DM组与治疗过程中血糖升高组相比OS和PFS的差异均无统计学意义(P值分别为0.557、0.463)。化疗期间血糖控制良好组的OS和PFS优于血糖控制差组(OS:P=0.037,PFS:P=0.007)。结论合并DM是影响DLBCL患者预后的重要因素,治疗过程中血糖升高与DLBCL患者的不良预后相关。

The prognostic impact of diabetic mellitus and hyperglycemia during DLBCL treatment on patients with diffuse large B-cell lymphoma

Objective This study aims to investigate the clinical features and prognostic factors of patients with diffuse large B-cell lymphoma(DLBCL)and assess the prognostic value of diabetes mellitus(DM)and hyperglycemia during DLBCL treatment in DLBCL.Methods The clinical data of 481 newly diagnosed DLBCL patients from January 1,2009 to December 31,2019 at Tianjin Medical University Cancer Institute and Hospital and Sun Yat-sen University Cancer Center were retrospectively collected,focusing on their blood glucose levels before and during treatment.Cox regression method was used for univariate analysis to assess prognostic factors,and the Kaplan-Meier method was used to draw survival curves to assess the prognostic value of DM and hyperglycemia during DLBCL treatment in patients with DLBCL.Results Eighty-two(17.0%)patients had DM before DLBCL diagnosis and treatment,and 88(18.3%)patients had at least one blood glucose increase during DLBCL treatment.Cox univariate analysis showed that age,Ann Arbor stage,international prognostic index,and DM were associated with overall survival(OS)and progression-free survival(PFS)(all P<0.05).The pairwise comparison between the two groups showed that the OS(P=0.001)and PFS(P<0.001)of patients with pre-existing DM were significantly worse than those of patients without abnormal blood glucose.Moreover,the OS(P=0.003)and PFS(P<0.001)of patients with hyperglycemia during DLBCL treatment were significantly worse than those of patients without abnormal blood glucose.No significant difference exists between patients with DM and patients with hyperglycemia during DLBCL treatment(OS,P=0.557;PFS,P=0.463).Additionally,patients with adequate glycemic control during chemotherapy had a better prognosis compared with patients with poor glycemic control(OS,P=0.037;PFS,P=0.007).Conclusion DM is an important factor affecting the prognosis of patients with DLBCL.Moreover,hyperglycemia during treatment is related to the poor prognosis of patients with DLBCL.