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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (6): 1089-1096. doi: 10.19723/j.issn.1671-167X.2024.06.023

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Impact of type 2 diabetes mellitus on the prognosis of patients with oral squamous cell carcinoma

Yaqing MAO1, Zhen CHEN1, Yao YU1, Wenbo ZHANG1, Yang LIU2,*(), Xin PENG1,*()   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2021-10-09 Online:2024-12-18 Published:2024-12-18
  • Contact: Yang LIU, Xin PENG E-mail:shannon13579@163.com;pxpengxin@263.net

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Abstract:

Objective: To analyze the influence of type 2 diabetes mellitus (DM) on the prognosis of oral squamous cell carcinoma (OSCC) patients with surgical treatment. Methods: The clinical data of 309 patients, who were diagnosed with OSCC and admitted to the same ward of Peking University Hospital of Stomatology from January 2014 to December 2017 were retrospectively reviewed, of whom, 104 were classified into DM group and 205 into non-DM group. The basic clinical data and follow-up results of the patients were analyzed and compared. Propensity score matching (PSM) was used to reduce confounding bias between the DM group and the non-DM group. Kaplan-Meier was used to calculate the survival rate of the two groups. Proportional hazards model was used to analyze the independent prognostic factors. The effect of glucose level on survival was analyzed. Results: After PSM, 77 patients in each group were matched and the variables were balanced. There were statistically significant differences in postoperative oral dysplasia and local recurrence between the two groups (P < 0.05). There was no significant difference in survival analysis between the two groups, but the survival rate of the DM group had the tendency to be lower than that of the non-DM group after matching. Univariate analysis and multiva-riate analysis both revealed that the tumor stage was an independent factor influencing the overall survival rate and tumor-specific survival rate of the OSCC patients (P < 0.05), while diabetes had no significant influence on the survival of the OSCC patients (P>0.05). Multivariate analysis showed that tumor stage, triglyceride level, preoperative mean capillary fasting blood glucose, postoperative mean postprandial blood glucose were indepen-dent prognostic factors for overall survival in the DM group. Tumor stage and mean postoperative postprandial blood glucose were independent prognostic factors for tumor-specific survival in the DM group. The risk of postoperative complications and distant metastasis in the DM group with poor glycemic control was higher than that in the good glycemic controls. Conclusion: There is no significant difference in overall survival and tumor-specific survival of the patients with or without DM. However, the possibility of mucosal dysplasia or local recurrence in the DM group is higher than that in the non-DM group. The tumor stage, triglyceride level and glycemic control of the patients with DM may affect their prognosis.

Key words: Oral squamous cell carcinoma, Diabetes mellitus, Prognosis, Propensity score matching

CLC Number: 

  • R739.8

Table 1

Baseline characteristics of the patients in two groups before and after PSM"

VariablesBefore PSM (n=309) After PSM (n=154)
DM (n=104) Non-DM (n=205) t/χ2/U P DM (n=77) Non-DM (n=77) t/χ2/U P
Gender 3.496 0.062 0.948 0.330
  Male 55 (52.9) 131 (63.9) 46 (59.7) 40 (51.9)
  Female 49 (47.1) 74 (36.1) 31 (40.3) 37 (48.1)
Age/years 14.661 0.005 1.928 0.749
   < 49 11 (10.6) 53 (25.9) 9 (11.7) 10 (13.0)
  50-59 33 (31.7) 61 (29.8) 25 (32.5) 30 (39.0)
  60-69 31 (29.8) 60 (29.3) 21 (27.3) 17 (22.1)
  70-79 25 (24.0) 29 (14.1) 19 (24.7) 19 (24.7)
  >80 4 (3.8) 2 (1.0) 3 (3.9) 1 (1.3)
Smoking 0.267 0.605 0.283 0.595
  Yes 29 (27.9) 63 (30.7) 24 (31.2) 21 (27.3)
  No 75 (72.1) 142 (69.3) 53 (68.8) 56 (72.7)
Alcohol 1.419 0.234 0.039 0.844
  Yes 32 (20.2) 54 (26.3) 17 (22.1) 16 (20.8)
  No 83 (79.8) 151 (73.7) 60 (77.9) 61 (79.2)
ACE 19.607 < 0.001 9.194 0.027
  0 33 (31.7) 117 (57.1) 27 (35.1) 11 (14.3)
  1 49 (47.1) 68 (33.2) 36 (46.8) 46 (59.7)
  2 16 (15.4) 16 (7.8) 12 (15.6) 16 (20.8)
  3 6 (5.8) 4 (2.0) 2 (2.6) 4 (5.2)
Resource 0.107 0.744 0.118 0.731
  Primary 95 (91.3) 185 (90.2) 72 (93.5) 73 (94.8)
  From dysplasia 9 (8.7) 20 (9.8) 5 (6.5) 4 (5.2)
Location 30.755 < 0.001 13.699 0.057
  Lip 5 (4.8) 3 (1.5) 4 (5.2) 2 (2.6)
  Root of tongue 5 (4.8) 2 (1.0) 5 (6.5) 1 (1.3)
  Body of tongue 29 (27.9) 90 (43.9) 19 (24.7) 26 (33.8)
  Superior gingiva 9 (8.7) 8 (3.9) 5 (6.5) 3 (3.9)
  Inferior gingiva 11 (10.6) 43 (21.0) 8 (10.4) 17 (22.1)
  Mouth floor 9 (8.7) 26 (12.7) 8 (10.4) 13 (16.9)
  Palate 7 (6.7) 6 (2.9) 5 (6.5) 4 (5.2)
  Cheek 29 (27.9) 27 (13.2) 23 (29.9) 11 (14.3)
Stage 32.877 < 0.001 1.111 0.892
  Ⅰ 23 (22.1) 15 (7.3) 10 (13.0) 10 (13.0)
  Ⅱ 25 (24.0) 18 (8.8) 15 (19.5) 13 (16.9)
  Ⅲ 27 (26.0) 94 (45.9) 26 (33.8) 32 (41.6)
  ⅣA 27 (26.0) 72 (35.1) 25 (32.5) 21 (27.3)
  ⅣB 2 (1.9) 6 (2.9) 1 (1.3) 1 (1.3)
Tumor grade 4.760 0.313 1.375 0.849
  SCC Ⅰ 44 (42.3) 65 (31.7) 29 (37.7) 30 (39.0)
  SCC Ⅰ-Ⅱ 33 (31.7) 76 (37.1) 25 (32.5) 25 (32.5)
  SCC Ⅱ 24 (23.1) 53 (25.9) 20 (26.0) 21 (27.3)
  SCC Ⅱ-Ⅲ 2 (1.9) 10 (4.9) 2 (2.6) 1 (1.3)
  SCC Ⅲ 1 (1.0) 1 (0.5) 1 (1.3) 0 (0)
Adjuvant therapy 34.537 < 0.001 5.214 0.074
  Yes 39 (37.5) 62 (30.2) 35 (45.5) 34 (44.2)
  No 65 (62.5) 122 (59.5) 42 (54.5) 38 (49.4)
  Unknown 0 (0) 21 (10.2) 0 (0) 5 (6.5)
LMR 4.79 (2.42) 5.42 (2.93) 9 023.0 0.027 5.27 (3.33) 4.92 (2.32) 2 776.5 0.497
NLR 2.05 (1.21) 1.81 (1.27) 9 584.0 0.147 2.06 (1.47) 2.03 (1.15) 2 956.5 0.977
A/G 1.68 (0.38) 1.63 (0.45) 9 825.5 0.261 1.62 (0.44) 1.64 (0.37) 2 785.0 0.516
CHO 4.53 (1.12) 4.41 (1.10) 10 156.0 0.497 4.42 (0.94) 4.59 (1.27) 2 612.5 0.203
TG 1.18 (0.71) 1.27 (0.74) 9 471.5 0.109 1.28 (0.84) 1.26 (0.76) 2 845.0 0.666
FBG 6.48 (2.05) 4.94 (0.65) 3 504.5 < 0.001 6.62 (2.09) 4.95 (0.60) 984.5 < 0.001

Figure 1

Postoperative prognosis of the patients in two groups before (A) and after (B) PSM PSM, propensity score matching; DM, diabetes mellitus. *P < 0.05, * *P < 0.01. PSM, propensity score matching; DM, diabetes mellitus."

Figure 2

Kaplan-Meier analysis of overall survival rate (A) and tumor-specific survival rate (B) of the patients in two groups before PSM PSM, propensity score matching; DM, diabetes mellitus."

Figure 3

Kaplan-Meier analysis of overall survival rate (A) and tumor-specific survival rate (B) of the patients in two groups after PSM"

Table 2

Multivariate Cox regression analysis of overall survival and tumor-specific survival of the OSCC patients"

VariablesOverall survival Tumor-specific survival
Before PSM (n=309) After PSM (n=154) Before PSM (n=309) After PSM (n=154)
95%CI P 95%CI P 95%CI P 95%CI P
DM 0.878-2.153 0.163 0.812-2.970 0.184 0.942-2.491 0.085 0.797-3.061 0.194
ACE 0.747-1.274 0.857 0.627-1.440 0.810 0.736-1.314 0.909 0.651-1.538 0.999
Grade 1.039-1.567 0.020 0.918-1.728 0.152 0.970-1.525 0.089 0.863-1.679 0.274
Tumor stage 1.248-2.090 < 0.001 1.313-2.798 0.001 1.413-2.505 < 0.001 1.290-2.876 0.001
Adjuvant therapy 0.715-1.729 0.638 0.321-1.141 0.121 0.628-1.640 0.949 0.363-1.357 0.293

Table 3

Univariate analysis of overall survival and tumor-specific survival of the DM patients"

VariablesOverall survival Tumor-specific survival
HR 95%CI P HR 95%CI P
Gender 1.287 0.656-2.523 0.463 1.000 0.638-2.677 0.465
Age 1.018 0.986-1.052 0.275 1.012 0.978-1.048 0.498
Smoking 0.551 0.228-1.331 0.186 0.515 0.197-1.347 0.176
Alcohol 0.532 0.187-1.511 0.236 0.444 0.135-1.464 0.182
Resource 0.042 0.000-5.063 0.195 0.042 0.000-6.978 0.224
Location 1.050 0.903-1.219 0.527 1.060 0.903-1.243 0.478
ACE 1.031 0.688-1.544 0.884 0.982 0.635-1.518 0.934
Tumor grade 1.230 0.877-1.727 0.231 1.196 0.830-1.723 0.338
Stage 1.455 1.060-1.997 0.020 1.679 1.182-2.385 0.004
Adjuvant therapy 0.627 0.125-3.141 0.570 1.056 0.508-2.194 0.884
LMR 0.961 0.820-1.125 0.615 0.940 0.792-1.116 0.481
NLR 1.117 0.840-1.486 0.446 1.171 0.876-1.566 0.287
A/G 0.614 0.205-1.845 0.385 0.373 0.105-1.321 0.126
CHO 0.861 0.595-1.245 0.425 0.925 0.637-1.345 0.685
TG 0.572 0.326-1.007 0.053 0.650 0.384-1.101 0.109
Duration of DM(year) 1.049 1.001-1.099 0.043 1.054 1.004-1.106 0.036
Therapy of DMa 1.357 0.940-1.960 0.103 1.472 0.989-2.190 0.057
FBG 1.178 0.989-1.403 0.066 1.183 0.989-1.416 0.066
CBG preoperative 1.364 1.131-1.646 0.001 1.286 1.039-1.591 0.021
PBG preoperative 1.091 0.971-1.225 0.142 1.191 0.977-1.240 0.114
CBG postoperative 1.155 0.996-1.340 0.057 1.223 1.048-1.428 0.011
PBG postoperative 1.287 1.097-1.511 0.002 1.376 1.156-1.639 < 0.001

Table 4

Multivariate Cox regression analysis of overall survival and tumor-specific survival of the DM patients"

VariablesOverall survival Tumor-specific survival
HR 95%CI P HR 95%CI P
Stage 1.432 1.016-2.019 0.040 1.694 1.139-2.520 0.009
TG 0.543 0.305-0.964 0.037 0.612 0.361-1.036 0.068
Duration of DM(year) 1.000 0.923-1.083 0.998 0.911 0.907-1.082 0.835
Therapy of DM 0.878 0.542-1.422 0.596 0.946 0.563-1.588 0.832
FBG 0.975 0.729-1.305 0.866 1.082 0.787-1.488 0.626
CBG preoperative 1.393 1.020-1.904 0.037 1.167 0.808-1.687 0.411
CBG postoperative 0.877 0.670-1.148 0.339 0.963 0.708-1.309 0.809
PBG postoperative 1.345 1.049-1.725 0.020 1.352 1.021-1.792 0.036

Table 5

Effect of blood glucose control on postoperative prognosis of the DM patients"

ItemsPreoperative blood glucose level Postoperative blood glucose level
Wella, n (%) Poorb, n (%) χ2 P Wellc, n (%) Poord, n (%) χ2 P
Postoperative complications 7 (10.4) 9 (24.3) 3.526 0.060 10 (13.2) 5 (20.8) 0.843 0.359
Oral dysplasia 11 (16.4) 4 (10.8) 0.607 0.436 11 (14.5) 4 (16.7) 0.069 0.793
Local recurrence 26 (38.8) 15 (40.5) 0.030 0.862 30 (39.5) 9 (37.5) 0.030 0.863
Lymph node metastasis 12 (17.9) 5 (13.5) 0.337 0.562 14 (18.4) 3 (12.5) 0.453 0.501
Distant metastasis 4 (6.1) 6 (16.2) 2.789 0.095 4 (5.3) 6 (26.1) 8.432 0.004
Tumor-specific death 18 (26.9) 12 (32.4) 0.360 0.549 19 (25.0) 10 (41.7) 2.461 0.117
All-cause death 20 (29.9) 13 (26.1) 0.422 0.516 22 (29.3) 10 (41.7) 1.264 0.261
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