Document Type : Research Articles
Authors
1
Dental Office, Dr Iqbal Dental Office, 160-33 Highland Ave Jamaica NY, 11432, United States.
2
Department of Medicine, Kushtia Medical College Hospital, Kushtia-7000, Bangladesh.
3
Department of Internal Medicine, Alraee Trust Hospital, Gujranwala, Pakistan.
4
Department of Pediatrics, BGC Trust Medical College Hospital & Chittagong City Corporation Memon Maternity Hospital, 55 Strand Road, Chattogram 4000, Bangladesh.
5
Center for Molecular Genetics, University of Karachi, Karachi-75270, Sindh, Pakistan.
6
King Edward Medical University, Mayo Hospital, Lahore, Pakistan.
7
Department of Public Health, Daffodil International University, Daffodil Smart City, Savar, Dhaka-1340, Bangladesh.
8
Department of Surgery, American University of Beirut Medical Center: AUBMC, Riad El Solh, Beirut, Lebanon.
Abstract
Background and Aims: Chronic comorbidities, including diabetes mellitus and hypertension, and gut microbial factors may influence chemotherapy response and survival in cancer patients. This study quantitatively evaluated their combined impact. The main objective of this study was to evaluate the impact of diabetes, hypertension, and gut microbial diversity on chemotherapy response and survival in cancer patients. Methods: A prospective cohort study enrolled 250 adult cancer patients receiving chemotherapy at a tertiary care center in Bangladesh. Clinical, metabolic, and microbiome data were collected at baseline and during treatment. Chemotherapy response was assessed by RECIST 1.1 criteria, while progression-free survival (PFS) and overall survival (OS) were recorded. Gut microbial diversity was measured using 16S rRNA sequencing. Statistical analyses included chi-square tests, t-tests, Kaplan–Meier survival analysis, and multivariable Cox regression. Results: Among participants, 32.8% had diabetes and 38.4% had hypertension. Objective response rates (CR+PR) were lower in patients with diabetes (41.5%) and hypertension (45.8%) compared with non-diabetic (57.1%) and normotensive (55.8%) patients (p < 0.05). Responders exhibited significantly lower HbA1c, fasting glucose, and systolic blood pressure than non-responders (p < 0.01). Higher gut microbial alpha diversity was observed in responders (Shannon index 4.1 ± 0.6) versus non-responders (3.4 ± 0.7; p < 0.001). Median PFS and OS were shorter in patients with diabetes (8.6 and 18.4 months) and hypertension (9.1 and 20.2 months) compared with those without comorbidities (12.9 and 26.7 months; 13.4 and 27.9 months, respectively). Multivariable analysis confirmed diabetes (aHR 1.58), hypertension (aHR 1.41), low microbial diversity (aHR 1.76), and advanced tumor stage (aHR 2.34) as independent predictors of worse survival (all p < 0.05). Conclusions: Diabetes, hypertension, and reduced gut microbial diversity are associated with poorer chemotherapy response and survival outcomes. Integrated management of metabolic and cardiovascular comorbidities, alongside microbiome-informed interventions, may enhance treatment efficacy and patient survival.
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