title: Hyperglycemia is associated with poor survival in primary central nervous system lymphoma patients.
abstract: OBJECTIVE
  Primary central nervous system lymphoma (PCNSL) is a type of non-Hodgkin lymphoma (NHL), and it has been postulated that metabolic disorder may contribute to NHL etiology. We retrospectively investigated the prognostic significance of hyperglycemia in patients with PCNSL. We evaluated glucose transporter type 1 (GLUT1) expression by immunohistochemistry and analyzed its association with hyperglycemia and survival.
  
  
  METHODS
  The medical and neuroradiologic records of 50 patients with PCNSL at our institution over the past 15 years were analyzed. Patients were divided into 3 groups based on mean fasting plasma glucose (FPG) levels: normal (<110 mg/dL), prediabetes (110-125 mg/dL), and diabetes (≥126 mg/dL). We defined prediabetes and diabetes groups as hyperglycemia.
  
  
  RESULTS
  Forty-four percent of patients were in the prediabetes and diabetes groups. One-year survival rates were 73%, 66%, and 43% in normal, prediabetes, and diabetes groups, respectively. Univariate analysis revealed that high age, female sex, poor performance status, high mean FPG, and monotherapy were associated with shorter survival. Multivariable Cox regression analyses showed that high mean FPG and monotherapy were significant predictors of shorter survival (p = 0.036 and p = 0.000, respectively). The GLUT1 immunohistopathologic staining was performed in 34 cases, 20 of which (58%) showed variable levels of GLUT1 expression at the cell membrane and/or cytoplasm. Prediabetes and diabetes groups had a higher percentage of GLUT1-positive cells compared with the normal group (p = 0.015).
  
  
  CONCLUSIONS
  These findings indicate that hyperglycemia is associated with poor survival. The putative biological mechanism might involve differential GLUT1 expression between hyperglycemic and normal states in patients with PCNSL.
authors.affiliation: Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki - Japan.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Debata
authors.affiliation: Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki - Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki - Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Ujifuku
authors.affiliation: Department of Pathology, Nagasaki University, Nagasaki - Japan.
authors.forename: Haruna
authors.initials: H
authors.lastname: Yasui
authors.affiliation: Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki - Japan.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Kamada
authors.affiliation: Nagasaki Educational and Diagnostic Center of Pathology, Nagasaki - Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Niino
authors.affiliation: Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki - Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsuo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D002462:Cell Membrane / Q000235:genetics; D016543:Central Nervous System Neoplasms / Q000097:blood / Q000209:etiology / Q000235:genetics* / Q000473:pathology; D048909:Diabetes Complications / Q000097:blood / Q000235:genetics* / Q000473:pathology; D003920:Diabetes Mellitus / Q000097:blood / Q000235:genetics* / Q000473:pathology; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D051272:Glucose Transporter Type 1 / Q000096:biosynthesis* / Q000235:genetics; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications / Q000235:genetics / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000209:etiology / Q000235:genetics* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D001786:Blood Glucose; D051272:Glucose Transporter Type 1; C495677:SLC2A1 protein, human