Meta-analysis Of The Correlation Between Lung Cancer And Diabetes Patients With Radiation Pneumonitis

Background: Lung cancer,the malignant tumor with the highest mortality rate in the world,requires about2/3 of lung cancer patients who require radiotherapy.Lung cancer patients with diabetes are common in the clinic.Diabetes can increase the risk of metabolic disorders,affect the patient’s tolerance to radiotherapy,and increase the risk and harm of radiation pneumonia.In recent years,due to the renewal and improvement of radiotherapy equipment,radiotherapy is more and more widely used in the treatment of lung cancer.It provides a physical basis for increasing the dose of the target area and reducing the amount of normal tissue.However,during radiotherapy,part of the normal lung tissue is inevitably exposed to a certain dose,which will damage the normal lung tissue and cause radiation pneumonitis.Radiation pneumonia not only limits the increase in target dose,affects the efficacy of radiotherapy,but also reduces the patient’s quality of life.Severe radiation pneumonia can even lead to patient death.Radiation pneumonia is a common and harmful complication of lung cancer radiotherapy,and it is also a problem that must be paid attention to in lung cancer radiotherapy.There is currently no evidence-based medicine report on whether the incidence of radiation pneumonia in patients with lung cancer and diabetes is higher than that in patients with lung cancer without diabetes.Objective: To comprehensively evaluate the correlation between the incidence and classification of lung cancer with diabetes and radiation pneumonia through Meta analysis,to understand whether the level of blood sugar control and the duration of diabetes affect the occurrence of radiation pneumonia,and to provide evidence-based medicine for the clinical prevention and treatment of radiation pneumonia.Method: Registration trial: Submit the research plan to the International prospective register of systematic reviews(PROSPERO)and apply for the registration code.Formulate a search strategy,search and build the database until January 2020,and publish it in Pub Med,Embase,Web of Science,Cochrane Library,Clinical Trails,CNKI,Wanfang,CQVIP and CBM,to compare multiple patients with lung cancer and diabetes(Case group)Clinical research reports of the incidence of radiation pneumonitis in patients with diabetes without lung cancer(control group),through the inclusion and exclusion criteria,screening literature and extracting data,according to the Newcastle-Ottawa Scale(NOS)evaluation The quality of the included data and Meta analysis of the included studies using Rev Man 5.3.Results: Registered and approved on PROSPERO(registration number: CRD42020156228).Finally,24case-control studies(CCS)were included,with a total of 3718 cases of lung cancer.The incidence rate of radiation pneumonitis in the lung cancer and diabetes patients group was 41.79%,significantly higher than that in the lung cancer patients group 18.40%(P<0.001),its OR=2.86,95%CI [2.39,3.42];Grade 1-3 in the lung cancer and diabetes patients group the incidence of radiation pneumonia was 17.65%,25.10%,7.98%,which was significantly higher than 4.55%,12%,and 4.67% of the lung cancer patients group(all P<0.05).The OR and 95%CI were: 4.11[1.55,10.91]、2.97[2.16,4.08]、1.75[1.09,2.81],P<0.05;Grade 4 radiation pneumonitis showed no statistically significant difference.Subgroup analysis of blood glucose control level showed that patients with better blood glucose control had lower incidence of radiation pneumonitis than patients with poor blood glucose control(29.44% vs 55.05%),the difference was statistically significant(OR=0.34,95%CI: 0.21～0.55,P<0.01);The relationship between the duration of diabetes and radiation pneumonitis was not statistically significant.Conclusion:Diabetes is a susceptible factor for radiation pneumonitis in lung cancer patients.Diabetes can increase the incidence of grade 1-3 radiation pneumonitis in lung cancer patients.Controlling blood sugar levels may reduce radiation pneumonitis,and provide effective clinical basis and reference for lung cancer patients to prevent and treat radiation pneumonia.