title: Confirmation of the role of diabetes in the local recurrence of surgically resected non-small cell lung cancer.
abstract: OBJECTIVE
  We recently demonstrated that diabetes mellitus was an independent risk factor for local recurrence (LR) for patients undergoing resection of non-small cell lung cancer (NSCLC). This investigation was performed to confirm or refute this finding in a different patient cohort.
  
  
  METHODS
  Patients were eligible if they did not have a second primary cancer within 5 years of the original diagnosis, had at least 3-month follow-up, and did not receive radiotherapy. There were 373 and 168 patients in the original (P1) and confirmatory (P2) cohorts, respectively, with 66 and 30 patients with diabetes.
  
  
  RESULTS
  The median follow-up was 33 months (range, 3-98 months). Diabetes was an independent risk factor for LR in a Cox model in both the P2 (p=0.05, hazard ratio [HR] 2.15) and P1 (p=0.008, HR 1.90) cohorts, separately from BMI, glucose control, and the presence of the metabolic syndrome. The rates of LR in the patients with diabetes after combining the cohorts at 2, 3, and 5 years were 23%, 33%, and 56%, respectively; these rates were 15%, 19%, and 26% in non-diabetics. In multivariate Cox regression and competing risk analysis of the combined cohorts, the HRs for LR in patients with diabetes exceeded those of more established risk factors for LR including a 1-cm increase in tumor size and lymphovascular invasion.
  
  
  CONCLUSIONS
  Diabetes was confirmed to be an independent predictor of the risk of LR following resection of NSCLC.
authors.affiliation: Penn State Hershey Cancer Institute, Hershey, PA 17033-0850, USA. jvarlotto@hmc.psu.edu
authors.forename: J
authors.initials: J
authors.lastname: Varlotto
authors.forename: L N
authors.initials: LN
authors.lastname: Medford-Davis
authors.forename: A
authors.initials: A
authors.lastname: Recht
authors.forename: J
authors.initials: J
authors.lastname: Flickinger
authors.forename: E
authors.initials: E
authors.lastname: Schaefer
authors.forename: J
authors.initials: J
authors.lastname: Shelkey
authors.forename: M
authors.initials: M
authors.lastname: Lazar
authors.forename: D
authors.initials: D
authors.lastname: Campbell
authors.forename: M
authors.initials: M
authors.lastname: Nikolov
authors.forename: M M
authors.initials: MM
authors.lastname: Decamp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors