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

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.