title: The Effect of Diabetes Mellitus on Lung Cancer Prognosis: A PRISMA-compliant Meta-analysis of Cohort Studies.
abstract: Previous studies suggested that diabetes mellitus (DM) was associated with risk and mortality of cancer, but studies investigating the correlation between DM and lung cancer prognosis remain controversial. Herein, a meta-analysis was performed to derive a more precise estimate of the prognostic role of DM in lung cancer.Medline and Embase were searched for eligible articles from inception to October 25, 2015. The pooled hazard ratio (HR) with its 95% confidence interval (95% CI) was calculated to evaluate the correlation between DM and lung cancer prognosis. Subgroup meta-analysis was performed based on the histology and the treatment methods.A total of 20 cohort studies from 12 articles were included in the meta-analysis. Also, 16 studies investigated the overall survival (OS) and 4 studies investigated the progression-free survival (PFS). DM was significantly associated with the inferior OS of lung cancer with the pooled HR 1.28 (95% CI: 1.10-1.49, P = 0.001). The association was prominent in the nonsmall cell lung cancer (NSCLC) subgroup (HR 1.35, 95%CI: 1.14-1.60, P = 0.002), whereas the association was not significant in the small cell lung cancer (SCLC) subgroup (HR 1.33, 95% CI: 0.87-2.03, P = 0.18). When NSCLC patients were further stratified by treatment methods, DM had more influence on the surgically treated subgroup than the nonsurgically treated subgroup. There was no obvious evidence for publication bias by Begg's and Egger's test.The results of this meta-analysis exhibit an association of DM with inferior prognosis amongst lung cancer patients, especially the surgically treated NSCLC patients. Given the small number of studies included in this meta-analysis, the present conclusion should be consolidated with more high-quality prospective cohort studies or randomized controlled trials.
authors.affiliation: From the Institute of Oncology (LZ, HC, TZ, LW), Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China; Department of Oncology (HS), Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China; Department of thoracic surgery (WD, JD), Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China.
authors.forename: Linhai
authors.initials: L
authors.lastname: Zhu
authors.forename: Hongxin
authors.initials: H
authors.lastname: Cao
authors.forename: Tiehong
authors.initials: T
authors.lastname: Zhang
authors.forename: Hongchang
authors.initials: H
authors.lastname: Shen
authors.forename: Wei
authors.initials: W
authors.lastname: Dong
authors.forename: Liguang
authors.initials: L
authors.lastname: Wang
authors.forename: Jiajun
authors.initials: J
authors.lastname: Du
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000401:mortality* / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D055752:Small Cell Lung Carcinoma / Q000150:complications / Q000401:mortality* / Q000628:therapy; D013223:Statistics as Topic; D016019:Survival Analysis