Faculty, Staff and Student Publications
Publication Date
9-2-2024
Journal
JNCI Cancer Spectrum
Abstract
Background: The consequence of diabetes on lung cancer overall survival (OS) is debated. This retrospective study used 2 large lung cancer databases to assess comprehensively diabetes effects on lung cancer OS in diverse demographic populations, including health disparity.
Methods: The University of Texas MD Anderson Cancer Center database (32 643 lung cancer patients with 11 973 patients with diabetes) was extracted from electronic health records (EHRs) using natural language processing (NLP). Associations were between diabetes and lung cancer prognostic features (age, sex, race, body mass index [BMI], insurance status, smoking, stage, and histopathology). Hemoglobin A1C (HgbA1c) and glucose levels assessed glycemic control. Validation was with a Louisiana cohort (17 768 lung cancer patients with 5402 patients with diabetes) enriched for health disparity cases. Kaplan-Meier analysis, log-rank test, multivariable Cox proportional hazard models, and survival tree analyses were employed.
Results: Lung cancer patients with diabetes exhibited marginally elevated OS or no statistically significant difference versus nondiabetic patients. When examining OS for 2 glycemic levels (HgbA1c > 7.0 or glucose > 154 mg/dL vs HgbA1c > 9.0 or glucose > 215 mg/dL), a statistically significant improvement in OS occurred in lung cancer patients with controlled versus uncontrolled glycemia (P < .0001). This improvement spanned sex, age, smoking status, insurance status, stage, race, BMI, histopathology, and therapy. Survival tree analysis revealed that obese and morbidly obese patients with controlled glycemia had higher lung cancer OS than comparison groups.
Conclusion: These findings indicate a need for optimal glycemic control to improve lung cancer OS in diverse populations with diabetes.
Keywords
Humans, Lung Neoplasms, Male, Female, Glycated Hemoglobin, Middle Aged, Retrospective Studies, Aged, Glycemic Control, Blood Glucose, Proportional Hazards Models, Diabetes Mellitus, Body Mass Index, Smoking, Kaplan-Meier Estimate, Louisiana, Sex Factors, Age Factors, Health Status Disparities, Databases, Factual, Prognosis, Texas, Insurance Coverage
DOI
10.1093/jncics/pkae081
PMID
39270065
PMCID
PMC11973429
PubMedCentral® Posted Date
9-12-2024
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Included in
Bioinformatics Commons, Biomedical Informatics Commons, Genetic Phenomena Commons, Medical Genetics Commons, Oncology Commons