Skip to main content

Advertisement

SpringerLink
Log in

Impact of diabetes mellitus on long-term prognosis after gastrectomy for advanced gastric cancer: a propensity score matching analysis

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

We investigated the long-term prognostic impact of diabetes mellitus (DM) after gastrectomy for advanced gastric cancer.

Methods

This was a retrospective cohort study of consecutive patients who underwent gastrectomy for primary p-T2 or more advanced-stage gastric cancer, between April, 2008 and June, 2018. The overall survival (OS) of patients with DM and those without DM were compared using Kaplan–Meier survival analysis after adjusting for group differences using propensity score matching (PSM).

Results

Among the 512 patients who met the eligibility criteria, 92 (18.0%) had DM and 420 (82.0%) did not. After PSM, the subjects of this analysis were 72 patients in the DM group and 216 patients in the non-DM. OS was significantly worse in the DM group than in the non-DM group (P = 0.037). Multivariate analysis revealed that a low skeletal muscle mass index was a significant independent prognostic factor for OS in the patients with DM (hazard ratio, 2.284; 95% confidence interval, 1.005–5.189; P = 0.048).

Conclusions

DM in patients with advanced gastric cancer is associated with poor OS. A low skeletal muscle mass in patients with DM is a particularly poor prognostic factor for OS after surgery for gastric cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.

    Article  Google Scholar 

  2. Miao ZF, Xu H, Xu YY, Wang ZN, Zhao TT, Song YX, et al. Diabetes mellitus and the risk of gastric cancer: a meta-analysis of cohort studies. Oncotarget. 2017;8:44881–92.

    Article  Google Scholar 

  3. Mazzone T. Intensive glucose lowering and cardiovascular disease prevention in diabetes: reconciling the recent clinical trial data. Circulation. 2010;122:2201–11.

    Article  Google Scholar 

  4. Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375:2215–22.

    Article  CAS  Google Scholar 

  5. Song S, Wang B, Zhang X, Hao L, Hu X, Li Z, et al. Long-term diabetes mellitus is associated with an increased risk of pancreatic cancer: a meta-analysis. PLoS One. 2015;10: e0134321.

    Article  Google Scholar 

  6. Guraya SY. Association of type 2 diabetes mellitus and the risk of colorectal cancer: a meta-analysis and systematic review. World J Gastroenterol. 2015;21:6026–31.

    Article  CAS  Google Scholar 

  7. Tian T, Zhang LQ, Ma XH, Zhou JN, Shen J. Diabetes mellitus and incidence and mortality of gastric cancer: a meta-analysis. Exp Clin Endocrinol Diabetes. 2012;120:217–23.

    Article  CAS  Google Scholar 

  8. Ge Z, Ben Q, Qian J, Wang Y, Li Y. Diabetes mellitus and risk of gastric cancer: a systematic review and meta-analysis of observational studies. Eur J Gastroenterol Hepatol. 2011;23:1127–35.

    Article  CAS  Google Scholar 

  9. Artham SM, Lavie CJ, Milani RV, Ventura HO. The obesity paradox: impact of obesity on the prevalence and prognosis of cardiovascular diseases. Postgrad Med. 2008;120:34–41.

    Article  Google Scholar 

  10. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53:1925–32.

    Article  Google Scholar 

  11. Colditz GA, Peterson LL. Obesity and cancer: evidence, impact, and future directions. Clin Chem. 2018;64:154–62.

    Article  CAS  Google Scholar 

  12. Lennon H, Sperrin M, Badrick E, Renehan AG. The obesity paradox in cancer: a review. Curr Oncol Rep. 2016;18:56.

    Article  Google Scholar 

  13. Aoyama T, Yoshikawa T, Shirai J, Hayashi T, Yamada T, Tsuchida K, et al. Body weight loss after surgery is an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer. Ann Surg Oncol. 2013;20:2000–6.

    Article  Google Scholar 

  14. Takayoshi K, Uchino K, Nakano M, Ikejiri K, Baba E. Weight loss during initial chemotherapy predicts survival in patients with advanced gastric cancer. Nutr Cancer. 2017;69:408–15.

    Article  CAS  Google Scholar 

  15. Hynes O, Anandavadivelan P, Gossage J, Johar AM, Lagergren J, Lagergren P. The impact of pre- and post-operative weight loss and body mass index on prognosis in patients with oesophageal cancer. Eur J Surg Oncol. 2017;43:1559–65.

    Article  CAS  Google Scholar 

  16. Aoyama T, Sato T, Maezawa Y, Kano K, Hayashi T, Yamada T, et al. Postoperative weight loss leads to poor survival through poor S-1 efficacy in patients with stage II/III gastric cancer. Int J Clin Oncol. 2017;22:476–83.

    Article  Google Scholar 

  17. Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, et al. ToGA Trial Investigators. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastrooesophageal junction cancer (ToGA): A phase 3, open-label, randomised controlled trial. Lancet. 2010;376:687–97.

    Article  CAS  Google Scholar 

  18. Zhang Y, Wang JP, Wang XL, Tian H, Gao TT, Tang LM, et al. Computed tomography-quantified body composition predicts short-term outcomes after gastrectomy in gastric cancer. Curr Oncol. 2018;25:e411–22.

    Article  CAS  Google Scholar 

  19. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  Google Scholar 

  20. Shimoyama S. Diabetes mellitus carries a risk of gastric cancer: a meta-analysis. World J Gastroenterol. 2013;19:6902–10.

    Article  Google Scholar 

  21. Sakitani K, Hirata Y, Suzuki N, Shichijo S, Yanai A, Serizawa T, et al. Gastric cancer diagnosed after Helicobacter pylori eradication in diabetes mellitus patients. BMC Gastroenterol. 2015;15:143.

    Article  Google Scholar 

  22. Sekikawa A, Fukui H, Maruo T, Tsumura T, Okabe Y, Osaki Y. Diabetes mellitus increases the risk of early gastric cancer development. Eur J Cancer. 2014;50:2065–71.

    Article  Google Scholar 

  23. Cheung KS, Chan EW, Wong AYS, Chen L, Seto WK, Wong ICK, et al. Metformin use and gastric cancer risk in diabetic patients after helicobacter pylori eradication. J Natl Cancer Inst. 2019;111:484–9.

    Article  Google Scholar 

  24. Seo HS, Jung YJ, Kim JH, Lee HH, Park CH. The effect of metformin on prognosis in patients with locally advanced gastric cancer associated with type 2 diabetes mellitus. Am J Clin Oncol. 2019;42:909–17.

    Article  CAS  Google Scholar 

  25. Sheng L, Peng H, Pan Y, Wang C, Zhu Y. Evaluating the effect of diabetes on the prognosis of gastric cancer using a propensity score matching method. J Gastrointest Oncol. 2020;11:999–1008.

    Article  Google Scholar 

  26. Chen X, Chen Y, Li T, Jun L, Lin T, Hu Y, et al. Impact of diabetes on prognosis of gastric cancer patients performed with gastrectomy. Chin J Cancer Res. 2020;32:631–44.

    Article  CAS  Google Scholar 

  27. Kamarajah SK, Bundred J, Tan BHL. Body composition assessment and sarcopenia in patients with gastric cancer: a systematic review and meta-analysis. Gastric Cancer. 2019;22:10–22.

    Article  Google Scholar 

  28. Yang Z, Zhou X, Ma B, Xing Y, Jiang X, Wang Z. Predictive value of preoperative sarcopenia in patients with gastric cancer: a meta-analysis and systematic review. J Gastrointest Surg. 2018;22:1890–902.

    Article  Google Scholar 

  29. Campins L, Camps M, Riera A, Pleguezuelos E, Yebenes JC, Serra-Prat M. Oral drugs related with muscle wasting and sarcopenia. A review. Pharmacology. 2017;99:1–8.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan

    Ryota Matsui, Noriyuki Inaki & Toshikatsu Tsuji

  2. Department of Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan

    Ryota Matsui

  3. Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan

    Noriyuki Inaki

Authors
  1. Ryota Matsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Noriyuki Inaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toshikatsu Tsuji
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Ryota Matsui and Noriyuki Inaki designed study. Ryota Matsui and Noriyuki Inaki performed the study. Ryota Matsui collected the data. Ryota Matsui analyzed the data. Ryota Matsui and Noriyuki Inaki wrote the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Noriyuki Inaki.

Ethics declarations

Conflict of interest

We have no conflicts of interest to declare.

Statement of informed consent

Informed consent was obtained from all participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsui, R., Inaki, N. & Tsuji, T. Impact of diabetes mellitus on long-term prognosis after gastrectomy for advanced gastric cancer: a propensity score matching analysis. Surg Today 52, 1382–1391 (2022). https://doi.org/10.1007/s00595-022-02482-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-022-02482-y

Keywords

Search

Navigation