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Diabetes mellitus als prognostischer Marker beim Oropharynx- und Larynxkarzinom

Diabetes mellitus as a prognostic marker in oropharyngeal and laryngeal squamous cell carcinoma

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Zusammenfassung

Aktuelle experimentelle und klinische Studien weisen darauf hin, dass Diabetes mellitus (DM) einen bedeutenden Risikofaktor bei verschiedenen Krebserkrankungen darstellt und sowohl die Pathogenese und Prognose beeinflussen kann. Zusätzlich weisen Antidiabetika wie z. B. Metformin eine antitumorigene Wirkung auf. Bis heute ist allerdings über die Rolle des DM bei der Pathogenese und Prognose von Plattenepithelkarzinomen der Kopf- und Halsregion (HNSCC) nur sehr wenig bekannt.

In einer retrospektiven monozentrischen Studie wurde der Einfluss des DM auf klinische und histopathologische Parameter von Patienten (n = 424), die an einem Oropharynx (OPSCC)- oder Larynxkarzinom (LaSCC) erkrankten, untersucht. Die Autoren beobachteten für das LaSCC einen deutlichen Anstieg in der relativen Anzahl der Patienten mit DM (<10 % bis 2005 und 20 % ab 2006), und DM war signifikant mit Unterschieden in klinischen und histopathologischen Eigenschaften der Patienten (Alter, Geschlecht, Tumorgröße und Differenzierung) assoziiert. Die DM-abhängigen Unterschiede bei klinischen und histopathologischen Eigenschaften variierten jedoch abhängig von der Lokalisation. Es zeigte sich ein Trend für ein schlechteres progressionsfreies Überleben und Gesamtüberleben bei Patienten mit DM unter den aktuellen Therapiemodalitäten.

Die vorliegenden Daten weisen auf einen relativen Anstieg an Patienten mit DM hin, was sich insbesondere beim LaSCC manifestiert. Dies könnte sich nachhaltig auf die Therapieplanung auswirken und sollte in zukünftigen klinischen Studien berücksichtigt werden. Ein besseres Verständnis der zellulären und molekularen Eigenschaften beim HNSCC mit DM könnte innovative Therapiestrategien im Sinne der personalisierten Medizin ermöglichen.

Abstract

Recent experimental and clinical studies have provided compelling evidence that diabetes mellitus (DM) is an important risk factor in various cancers, and may affect both pathogenesis and prognosis. Additionally, antidiabetic agents such as metformin exhibit an antitumorigenic effect. However, to date there is insufficient knowledge about the role of DM in the pathogenesis and prognosis of head and neck squamous cell carcinoma (HNSCC).

In a retrospective monocentric study including 424 patients with SCC of the oropharynx (OPSCC) or larynx (LaSCC), the impact of DM on clinical and histopathologic parameters was investigated. The authors found a rising incidence of DM among LaSCC patients (<10 % until 2005 and 20 % since 2006) and a significant association between DM and clinical and histopathologic features (age, gender, tumor size, and pathologic grading), which depended on the anatomic site. Moreover, a clear trend toward unfavorable progression-free and overall survival of HNSCC patients with DM upon current treatment modalities was evident.

The presented data support a relative increase in patients with DM, particularly for LaSCC. This might have a sustained influence on treatment decisions and management, and should be considered in future clinical trials. A better understanding of the cellular and molecular traits of HNSCC in DM could pave the way for innovative therapeutic strategies in terms of personalized medicine.

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Authors and Affiliations

  1. Sektion Experimentelle und Translationale Kopf-Hals-Onkologie, Hals-Nasen-Ohrenklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    K. Zaoui, J. Doll, P. Stiebi, P. Federspil, P. K. Plinkert & J. Hess

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  1. K. Zaoui
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  2. J. Doll
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Correspondence to K. Zaoui.

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K. Zaoui, J. Doll, P. Stiebi, P. Federspil, P.K. Plinkert und J. Hess geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Zaoui, K., Doll, J., Stiebi, P. et al. Diabetes mellitus als prognostischer Marker beim Oropharynx- und Larynxkarzinom. HNO 64, 479–486 (2016). https://doi.org/10.1007/s00106-016-0177-z

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