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CC BY-NC-ND 4.0 · South Asian J Cancer 2023; 12(02): 118-125
DOI: 10.1055/s-0043-1764316
Original Article
Breast Cancer

Link between Blood Cell-Associated Inflammatory Indices and Chemotherapy-Induced Hyperglycemia in Women Affected with Breast Cancer: Clinical Studies

Krishna Prasad 
1   Department of Medical Oncology, Mangalore Institute of Oncology, Pumpwell, Mangaluru, Karnataka, India
,
Suresh Rao
2   Department of Radiation Oncology, Mangalore Institute of Oncology, Pumpwell, Mangaluru, Karnataka, India
,
Sanath Kumar Hegde
2   Department of Radiation Oncology, Mangalore Institute of Oncology, Pumpwell, Mangaluru, Karnataka, India
,
Thomas George
3   Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangaluru, Karnataka, India
,
Rhea Katherine D'souza
3   Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangaluru, Karnataka, India
,
Sucharitha Suresh
4   Department of Community Medicine, Father Muller Medical College, Kankanady, Mangaluru, Karnataka, India
,
Manjeshwar Shrinath Baliga 
3   Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangaluru, Karnataka, India
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Abstract

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Krishna Prasad

Background Development of treatment-induced hyperglycemia/diabetes is a considerable problem in women undergoing chemotherapy for breast cancer. In this study, baseline levels of blood cell-associated inflammatory indices (BCAII) were analyzed to understand their role in the development of treatment-induced hyperglycemia and diabetogenesis.

Materials and Methods This was a retrospective study, and information on women who were normoglycemic and nondiabetic and of women who were diabetic at the beginning of the treatment were collected from files. Demographic, pathology-related details, and complete blood profile were noted. Neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory index (SII) which indicate BCAII were calculated. Demographic details were subjected to frequency and percentage, while blood parameters were subjected to one-way analysis of variance followed by post hoc Bonferroni's multiple comparison tests. A p-value of <0.05 was considered significant.

Results The results indicated that a significant difference in levels of total count (p < 0.035), neutrophil, lymphocyte, and platelets (p < 0.001) were observed. Regarding BCAII, when compared with women who were normoglycemic at the end of treatment, NLR, dNLR, PLR, and SII were significantly high for people who were known diabetics at the beginning of treatment (p < 0.001). The dNLR (p = 0.0008), PLR (p < 0.001), and SII (p < 0.001) were significant for people who developed secondary hyperglycemia/diabetes, while only dNLR was significant for people who progressed from normal to prediabetes stage (p = 0.049)

Conclusion To the best of the authors' knowledge, this is the first study that indicates difference in baseline BCAII and development of treatment-induced hyperglycemia/diabetes indicating that underlying low levels of inflammation may contribute to diabetogenesis in women affected with breast cancer.

Keywords

breast cancer - secondary hyperglycemia/diabetes - treatment-induced hyperglycemia/diabetes - blood cell-associated inflammatory indices - neutrophil-to-lymphocyte ratio - derived neutrophil-to-lymphocyte ratio - platelet-to-lymphocyte ratio - systemic inflammatory index


Publication History

Article published online:
09 March 2023

© 2023. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 World Health Organization. Breast cancer. Accessed January 31st 2022 at: https://www.who.int/news-room/fact-sheets/detail/breast-cancer
  • 2 Anonymous. Latest Statistics of Breast Cancer in India. Accessed January 31st 2022 at: https://www.breastcancerindia.net/statistics/trends.html
  • 3 Sharma GN, Dave R, Sanadya J, Sharma P, Sharma KK. Various types and management of breast cancer: an overview. J Adv Pharm Technol Res 2010; 1 (02) 109-126
    CrossrefPubMedSearch in Google Scholar
  • 4 Majeed W, Aslam B, Javed I. et al. Breast cancer: major risk factors and recent developments in treatment. Asian Pac J Cancer Prev 2014; 15 (08) 3353-3358
    CrossrefPubMedSearch in Google Scholar
  • 5 Janelsins MC, Tejani MA, Kamen C, Peoples AR, Mustian KM, Morrow GR. Current pharmacotherapy for chemotherapy-induced nausea and vomiting in cancer patients. Expert Opin Pharmacother 2013; 14 (06) 757-766
    CrossrefPubMedSearch in Google Scholar
  • 6 Fathallah N, Slim R, Larif S, Hmouda H, Ben Salem C. Drug-induced hyperglycaemia and diabetes. Drug Saf 2015; 38 (12) 1153-1168
    CrossrefPubMedSearch in Google Scholar
  • 7 Rao S, Prasad K, George T, Abraham S, Supreeth KC, Baliga MS. Incidence of secondary hyperglycemia/diabetes in women who have undergone curative chemotherapy for breast cancer: first study from India. South Asian J Cancer 2020; 9 (03) 130-135
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Jeong Y, Han HS, Lee HD. et al. A pilot study evaluating steroid-induced diabetes after antiemetic dexamethasone therapy in chemotherapy-treated cancer patients. Cancer Res Treat 2016; 48 (04) 1429-1437
    CrossrefPubMedSearch in Google Scholar
  • 9 Hwangbo Y, Lee EK. Acute hyperglycemia associated with anti-cancer medication. Endocrinol Metab (Seoul) 2017; 32 (01) 23-29
    CrossrefPubMedSearch in Google Scholar
  • 10 Vidler J, Rogers C, Yallop D. et al. Outpatient management of steroid-induced hyperglycaemia and steroid-induced diabetes in people with lymphoproliferative disorders treated with intermittent high dose steroids. J Clin Transl Endocrinol 2017; 9: 18-20
    PubMedSearch in Google Scholar
  • 11 Hickish T, Astras G, Thomas P. et al. Glucose intolerance during adjuvant chemotherapy for breast cancer. J Natl Cancer Inst 2009; 101 (07) 537
    CrossrefPubMedSearch in Google Scholar
  • 12 Agnoli C, Berrino F, Abagnato CA. et al. Metabolic syndrome and postmenopausal breast cancer in the ORDET cohort: a nested case-control study. Nutr Metab Cardiovasc Dis 2010; 20 (01) 41-48
    CrossrefPubMedSearch in Google Scholar
  • 13 Lu LJ, Wang RJ, Ran L. et al. On the status and comparison of glucose intolerance in female breast cancer patients at initial diagnosis and during chemotherapy through an oral glucose tolerance test. PLoS One 2014; 9 (04) e93630
    CrossrefPubMedSearch in Google Scholar
  • 14 Juanjuan L, Wen W, Zhongfen L. et al. Clinical pathological characteristics of breast cancer patients with secondary diabetes after systemic therapy: a retrospective multicenter study. Tumour Biol 2015; 36 (09) 6939-6947
    CrossrefPubMedSearch in Google Scholar
  • 15 Dieli-Conwright CM, Wong L, Waliany S, Bernstein L, Salehian B, Mortimer JE. An observational study to examine changes in metabolic syndrome components in patients with breast cancer receiving neoadjuvant or adjuvant chemotherapy. Cancer 2016; 122 (17) 2646-2653
    CrossrefPubMedSearch in Google Scholar
  • 16 Heo J, Chun M, Oh YT, Noh OK, Kim L. Metabolic comorbidities and medical institution utilization among breast cancer survivors: a national population-based study. Korean J Intern Med (Korean Assoc Intern Med) 2020; 35 (02) 421-428
    PubMedSearch in Google Scholar
  • 17 Brady VJ, Grimes D, Armstrong T, LoBiondo-Wood G. Management of steroid-induced hyperglycemia in hospitalized patients with cancer: a review. Oncol Nurs Forum 2014; 41 (06) E355-E365
    CrossrefPubMedSearch in Google Scholar
  • 18 Suh S, Park MK. Glucocorticoid-induced diabetes mellitus: an important but overlooked problem. Endocrinol Metab (Seoul) 2017; 32 (02) 180-189
    CrossrefPubMedSearch in Google Scholar
  • 19 Abudawood M. Diabetes and cancer: a comprehensive review. J Res Med Sci 2019; 24: 94
    CrossrefPubMedSearch in Google Scholar
  • 20 Wang M, Yang Y, Liao Z. Diabetes and cancer: epidemiological and biological links. World J Diabetes 2020; 11 (06) 227-238
    CrossrefPubMedSearch in Google Scholar
  • 21 Li X, Teng L, Yang Z. Editorial: from chronic inflammation to cancer: how far can immunotherapy go?. Front Pharmacol 2022; 12: 838917
    CrossrefPubMedSearch in Google Scholar
  • 22 Tsalamandris S, Antonopoulos AS, Oikonomou E. et al. The role of inflammation in diabetes: current concepts and future perspectives. Eur Cardiol 2019; 14 (01) 50-59
    CrossrefPubMedSearch in Google Scholar
  • 23 Xu CX, Zhu HH, Zhu YM. Diabetes and cancer: associations, mechanisms, and implications for medical practice. World J Diabetes 2014; 5 (03) 372-380
    CrossrefPubMedSearch in Google Scholar
  • 24 Wu Y, Liu Y, Dong Y, Vadgama J. Diabetes-associated dysregulated cytokines and cancer. Integr Cancer Sci Ther 2016; 3 (01) 370-378
    PubMedSearch in Google Scholar
  • 25 Liu C, Huang Z, Wang Q. et al. Usefulness of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in hormone-receptor-negative breast cancer. OncoTargets Ther 2016; 9: 4653-4660
    CrossrefPubMedSearch in Google Scholar
  • 26 Fest J, Ruiter R, Mulder M. et al. The systemic immune-inflammation index is associated with an increased risk of incident cancer-a population-based cohort study. Int J Cancer 2020; 146 (03) 692-698
    CrossrefPubMedSearch in Google Scholar
  • 27 Mertoglu C, Gunay M. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as useful predictive markers of prediabetes and diabetes mellitus. Diabetes Metab Syndr 2017; 11 (Suppl. 01) S127-S131
    CrossrefPubMedSearch in Google Scholar
  • 28 World Health Organization. Breast cancer. Accessed January 31st 2022 at: https://www.who.int/cancer/prevention/diagnosis-screening/breast-cancer/en/
  • 29 Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; 15 (07) 539-553
    CrossrefPubMedSearch in Google Scholar
  • 30 World Health Organization. Guidelines for the prevention, management and care of diabetes mellitus. Khatib OMN (Editor); 2006. Accessed January 31st 2022 at: http://applicationsemrowhoint/dsaf/dsa664pdf
  • 31 Khokhar A. Breast cancer in India: where do we stand and where do we go?. Asian Pac J Cancer Prev 2012; 13 (10) 4861-4866
    CrossrefPubMedSearch in Google Scholar
  • 32 Malvia S, Bagadi SA, Dubey US, Saxena S. Epidemiology of breast cancer in Indian women. Asia Pac J Clin Oncol 2017; 13 (04) 289-295
    CrossrefPubMedSearch in Google Scholar
  • 33 Kokiwar PR, Kumar HB, Mubashare A. Epidemiological and clinical profile of breast cancer patients at a tertiary care hospital in South India. J Cancer Res Ther 2011; 7 (01) 95
    CrossrefPubMedSearch in Google Scholar
  • 34 Thakur KK, Bordoloi D, Kunnumakkara AB. Alarming burden of triple-negative breast cancer in India. Clin Breast Cancer 2018; 18 (03) e393-e399
    CrossrefPubMedSearch in Google Scholar
  • 35 Lipscombe LL, Chan WW, Yun L, Austin PC, Anderson GM, Rochon PA. Incidence of diabetes among postmenopausal breast cancer survivors. Diabetologia 2013; 56 (03) 476-483
    CrossrefPubMedSearch in Google Scholar
  • 36 Gironés R, Torregrosa D, Díaz-Beveridge R. Comorbidity, disability and geriatric syndromes in elderly breast cancer survivors. Results of a single-center experience. Crit Rev Oncol Hematol 2010; 73 (03) 236-245
    CrossrefPubMedSearch in Google Scholar
  • 37 Gallagher EJ, LeRoith D, Franco R. et al. Metabolic syndrome and pre-diabetes contribute to racial disparities in breast cancer outcomes: hypothesis and proposed pathways. Diabetes Metab Res Rev 2016; 32 (07) 745-753
    CrossrefPubMedSearch in Google Scholar
  • 38 Gallagher EJ, Fei K, Feldman SM. et al. Insulin resistance contributes to racial disparities in breast cancer prognosis in US women. Breast Cancer Res 2020; 22 (01) 40
    CrossrefPubMedSearch in Google Scholar
  • 39 Fest J, Ruiter R, Ikram MA, Voortman T, van Eijck CHJ, Stricker BH. Reference values for white blood-cell-based inflammatory markers in the Rotterdam Study: a population-based prospective cohort study. Sci Rep 2018; 8 (01) 10566
    CrossrefPubMedSearch in Google Scholar
  • 40 Liu N, Sheng J, Pan T, Wang Y. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are associated with lower extremity vascular lesions in Chinese patients with type 2 diabetes. Clin Lab 2019; 65 (03)
    CrossrefPubMedSearch in Google Scholar
  • 41 Demirdal T, Sen P. The significance of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and lymphocyte-monocyte ratio in predicting peripheral arterial disease, peripheral neuropathy, osteomyelitis and amputation in diabetic foot infection. Diabetes Res Clin Pract 2018; 144: 118-125
    CrossrefPubMedSearch in Google Scholar