title: Impact of glycemia on survival of glioblastoma patients treated with radiation and temozolomide.
abstract: Evidence suggests hyperglycemia is associated with worse outcomes in glioblastoma (GB). This study aims to confirm the association between glycemia during radiotherapy (RT) and temozolomide (TMZ) treatment and overall survival (OS) in patients with newly diagnosed GB. This retrospective study included GB patients treated with RT and TMZ from 2004 to 2011, randomly divided into independent derivation and validation datasets. Time-weighted mean (TWM) glucose and dexamethasone dose were collected from start of RT to 4 weeks after RT. Univariate (UVA) and multivariable (MVA) analyses investigated the association of TWM glucose and other prognostic factors with overall survival (OS). In total, 393 patients with median follow-up of 14 months were analyzed. In the derivation set (n = 196) the median OS was 15 months and median TWM glucose was 6.3 mmol/L. For patients with a TWM glucose ≤6.3 and >6.3 mmol/L, median OS was 16 and 13 months, respectively (p = 0.03). On UVA, TWM glucose, TWM dexamethasone, age, extent of surgery, and performance status were associated with OS. On MVA, TWM glucose remained an independent predictor of OS (p = 0.03) along with TWM dexamethasone, age, and surgery. The validation set (n = 197), with similar baseline characteristics, confirmed that TWM glucose ≤6.3 mmol/L was independently associated with longer OS (p = 0.005). This study demonstrates and validates that glycemia is an independent predictor for survival in GB patients treated with RT and TMZ.
authors.affiliation: Department of Radiation Oncology, University of Toronto/ University Health Network-Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5T 2M9, Canada.
authors.forename: Minh Thi
authors.initials: MT
authors.lastname: Tieu
authors.forename: Leif E
authors.initials: LE
authors.lastname: Lovblom
authors.forename: Mairéad G
authors.initials: MG
authors.lastname: McNamara
authors.forename: Warren
authors.initials: W
authors.lastname: Mason
authors.forename: Normand
authors.initials: N
authors.lastname: Laperriere
authors.forename: Barbara-Ann
authors.initials: BA
authors.lastname: Millar
authors.forename: Cynthia
authors.initials: C
authors.lastname: Ménard
authors.forename: Tim-Rasmus
authors.initials: TR
authors.lastname: Kiehl
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Perkins
authors.forename: Caroline
authors.initials: C
authors.lastname: Chung
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D005909:Glioblastoma / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D018931:Antineoplastic Agents, Hormonal; D003606:Dacarbazine; D003907:Dexamethasone; D000077204:Temozolomide