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Impact of Pre-existing Type-2 Diabetes on Patient Outcomes After Radical Resection for Gastric Cancer: A Retrospective Cohort Study

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Abstract

Background

The aim of this study was to evaluate the impact of pre-existing type-2 diabetes on postoperative recovery and prognosis in gastric cancer (GC) patients who underwent radical gastrectomy.

Research Design and Methods

From June 2001 to June 2011, a total of 1,014 eligible patients were enrolled. Among them, 67 patients were diagnosed with type-2 diabetes. The clinicopathologic features and prognostic data were compared between patients with type-2 diabetes (the DM group) and without diabetes (the non-DM group).

Results

Median survival was 68.3 months. The 5-year overall survival in the DM group was similar to that in the non-DM group (52.1 vs. 53.0 %, p = 0.411). Propensity score matching analysis demonstrated that the hazard ratio of death in the DM group was 1.191 (95 % confidential index 0.693–2.072; p = 0.531) compared to the-non DM group. Incidence of postoperative complications was higher in the DM group than in the non-DM group (17.9 vs. 8.1 %, p = 0.006). The DM remission rate was 46 % among patients who received Roux-en-Y reconstruction, and 13 % among patients who received Billroth II anastomosis (p = 0.009). The 5-year overall survival rate was 62.1 % for patients with cured or improved DM and 23.4 % for patients with worse or same DM status (p = 0.003).

Conclusion

Type-2 diabetes can be cured by radical gastrectomy plus Roux-en-Y reconstruction in some GC patients. Pre-existing diabetes is associated with increased postoperative complications and decreased survival when it becomes worse after curative dissection for GC.

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References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.

    Article  PubMed  Google Scholar 

  2. Zhang CH, Zhan WH, He YL, Chen CQ, Huang MJ, Cai SR. Spleen preservation in radical surgery for gastric cardia cancer. Ann Surg Oncol. 2007;14:1312–1319.

    Article  PubMed  Google Scholar 

  3. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.

    Article  PubMed  Google Scholar 

  4. Sun X, Mu R, Zhou Y, et al. 1990–1992 mortality of stomach cancer in china. Zhonghua Zhong Liu Za Zhi. 2002;24:4–8.

    PubMed  Google Scholar 

  5. Sym SJ, Chang HM, Ryu MH, et al. Neoadjuvant docetaxel, capecitabine and cisplatin (dxp) in patients with unresectable locally advanced or metastatic gastric cancer. Ann Surg Oncol. 2010;17:1024–1032.

    Article  PubMed  Google Scholar 

  6. Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345:725–730.

    Article  PubMed  CAS  Google Scholar 

  7. Wu Y, Wei ZW, He YL, et al. Efficacy of adjuvant xelox and folfox6 chemotherapy after d2 dissection for gastric cancer. World J Gastroenterol. 2013;19:3309–3315.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage. Ann Surg Oncol. 2007;14:317–328.

    Article  PubMed  Google Scholar 

  9. Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after d2 gastrectomy (classic): a phase 3 open-label, randomised controlled trial. Lancet. 2012;379:315–321.

    Article  PubMed  CAS  Google Scholar 

  10. Melmed S, Polonsky KS, Larsen PRMD, Kronenberg HM. Williams textbook of endocrinology: expert consult. Amsterdam: Elsevier Health Sciences; 2011.

    Google Scholar 

  11. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–1053.

    Article  PubMed  Google Scholar 

  12. Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in china. N Engl J Med. 2010;362:1090–1101.

    Article  PubMed  CAS  Google Scholar 

  13. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352:854–865.

    Google Scholar 

  14. Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299:316–323.

    Article  PubMed  CAS  Google Scholar 

  15. Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002;236:554–559.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Coughlin SS, Calle EE, Teras LR, Petrelli J, Thun MJ. Diabetes mellitus as a predictor of cancer mortality in a large cohort of us adults. Am J Epidemiol. 2004;159:1160–1167.

    Article  PubMed  Google Scholar 

  17. Tseng CH. Diabetes conveys a higher risk of gastric cancer mortality despite an age-standardised decreasing trend in the general population in Taiwan. Gut. 2011;60:774–779.

    Article  PubMed  Google Scholar 

  18. Brolin RE. Update: NIH consensus conference. Gastrointestinal surgery for severe obesity. Nutrition. 1996;12:403–404.

    Article  PubMed  CAS  Google Scholar 

  19. Sjostrom L, Gummesson A, Sjostrom CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish obese subjects study): a prospective, controlled intervention trial. Lancet Oncol. 2009;10:653–662.

    Article  PubMed  Google Scholar 

  20. Schernthaner G, Brix JM, Kopp HP, Schernthaner GH. Cure of type 2 diabetes by metabolic surgery? A critical analysis of the evidence in 2010. Diabetes Care. 2011;34:S355–S360.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Japanese Gastric Cancer. A: Japanese classification of gastric carcinoma—2nd English edition. Gastric cancer. 1998;1:10–24.

    Article  Google Scholar 

  22. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

    Google Scholar 

  23. American Diabetes Association. Standards of medical care in diabetes—2007. Diabetes Care. 2007;30:S4–S41.

    Google Scholar 

  24. Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32:2133–2135.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Brookhart MA, Schneeweiss S, Rothman KJ, Glynn RJ, Avorn J, Sturmer T. Variable selection for propensity score models. Am J Epidemiol. 2006;163:1149–1156.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Newgard CD, Hedges JR, Arthur M, Mullins RJ. Advanced statistics: the propensity score—a method for estimating treatment effect in observational research. Acad Emerg Med. 2004;11:953–961.

    Article  PubMed  Google Scholar 

  27. Schrauder MG, Fasching PA, Haberle L, et al. Diabetes and prognosis in a breast cancer cohort. J Cancer Res Clin Oncol. 2011;137:975–983.

    Article  PubMed  Google Scholar 

  28. Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst. 2005;97:1679–1687.

    Article  PubMed  Google Scholar 

  29. El-Serag HB, Hampel H, Javadi F. The association between diabetes and hepatocellular carcinoma: a systematic review of epidemiologic evidence. Clin Gastroenterol Hepatol. 2006;4:369–380.

    Article  PubMed  Google Scholar 

  30. Friberg E, Orsini N, Mantzoros CS, Wolk A. Diabetes mellitus and risk of endometrial cancer: a meta-analysis. Diabetologia. 2007;50:1365–1374.

    Article  PubMed  CAS  Google Scholar 

  31. Woolcott CG, Maskarinec G, Haiman CA, Henderson BE, Kolonel LN. Diabetes and urothelial cancer risk: the multiethnic cohort study. Cancer Epidemiol. 2011;35:551–554.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Swerdlow AJ, Laing SP, Qiao Z, et al. Cancer incidence and mortality in patients with insulin-treated diabetes: a UK cohort study. Br J Cancer. 2005;92:2070–2075.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  33. Batty GD, Shipley MJ, Marmot M, Smith GD. Diabetes status and post-load plasma glucose concentration in relation to site-specific cancer mortality: findings from the original Whitehall study. Cancer Causes Control. 2004;15:873–881.

    Article  PubMed  Google Scholar 

  34. Verlato G, Zoppini G, Bonora E, Muggeo M. Mortality from site-specific malignancies in type 2 diabetic patients from Verona. Diabetes Care. 2003;26:1047–1051.

    Article  PubMed  Google Scholar 

  35. Wu CW, Hsieh MC, Lo SS, et al. Prognostic indicators for survival after curative resection for patients with carcinoma of the stomach. Dig Dis Sci. 1997;42:1265–1269.

    Article  PubMed  CAS  Google Scholar 

  36. Ogihara S, Yamada M, Saito T, Shono M, Rokutan K. Insulin potentiates mitogenic effect of epidermal growth factor on cultured guinea pig gastric mucous cells. Am J Physiol. 1996;271:G104–G112.

    PubMed  CAS  Google Scholar 

  37. Yoshizawa N, Yamaguchi H, Yamamoto M, et al. Gastric carcinogenesis by n-methyl-n-nitrosourea is enhanced in db/db diabetic mice. Cancer Sci. 2009;100:1180–1185.

    Article  PubMed  CAS  Google Scholar 

  38. Dandona P, Thusu K, Cook S, et al. Oxidative damage to DNA in diabetes mellitus. Lancet. 1996;347:444–445.

    Article  PubMed  CAS  Google Scholar 

  39. Lorenzi M, Montisano DF, Toledo S, Barrieux A. High glucose induces DNA damage in cultured human endothelial cells. J Clin Invest. 1986;77:322–325.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  40. Angervall L, Dotevall G, Tillander H. Amelioration of diabetes mellitus following gastric resection. Acta Med Scand. 1961;169:743–748.

    Article  PubMed  CAS  Google Scholar 

  41. Kim JW, Cheong JH, Hyung WJ, Choi SH, Noh SH. Outcome after gastrectomy in gastric cancer patients with type 2 diabetes. World J Gastroenterol. 2012;18:49–54.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Lee W, Ahn SH, Lee JH, et al. Comparative study of diabetes mellitus resolution according to reconstruction type after gastrectomy in gastric cancer patients with diabetes mellitus. Obes Surg. 2012;22:1238–1243.

    Article  PubMed  Google Scholar 

  43. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366:1577–1585.

    Article  PubMed  CAS  Google Scholar 

  44. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–1576.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  45. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:e245.

    Article  Google Scholar 

  46. Saeidi N, Meoli L, Nestoridi E, et al. Reprogramming of intestinal glucose metabolism and glycemic control in rats after gastric bypass. Science. 2013;341:406–410.

    Article  PubMed  CAS  Google Scholar 

  47. Wang H, Zhou XB, Zhou YB, et al. Multivariate logistic regression analysis of postoperative severe complications and discriminant model establishment in gastric cancer post gastrectomy. Zhonghua Wai Ke Za Zhi. 2008;46:1902–1905.

    PubMed  Google Scholar 

  48. Yanaga K, Matsumata T, Hayashi H, et al. Effect of diabetes mellitus on hepatic resection. Arch Surg. 1993;128:445–448.

    Article  PubMed  CAS  Google Scholar 

  49. Little SA, Jarnagin WR, DeMatteo RP, Blumgart LH, Fong Y. Diabetes is associated with increased perioperative mortality but equivalent long-term outcome after hepatic resection for colorectal cancer. J Gastrointest Surg. 2002;6:88–94.

    Article  PubMed  Google Scholar 

  50. Golden SH, Peart-Vigilance C, Kao WH, Brancati FL. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care. 1999;22:1408–1414.

    Article  PubMed  CAS  Google Scholar 

  51. Dronge AS, Perkal MF, Kancir S, Concato J, Aslan M, Rosenthal RA. Long-term glycemic control and postoperative infectious complications. Arch Surg. 2006;141:375–380.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to acknowledge the assistance of Donglian Chen in maintaining our database. This study was supported by the National Natural Science Foundation of China (30700805, 81272637 and 81272643).

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Authors and Affiliations

  1. Department of Gastrointestinopancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China

    Zhe-Wei Wei, Ying Wu, Guang-Kai Xia, Yu-Long He & Chang-Hua Zhang

  2. Gastric Cancer Center, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China

    Zhe-Wei Wei, Ying Wu, Guang-Kai Xia, Yu-Long He & Chang-Hua Zhang

  3. Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China

    Jia-Ling Li

  4. IU Health Goshen Center for Cancer Care, Indiana University, 200 High Park Avenue, Goshen, IN, 46526, USA

    Roderich E. Schwarz

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  1. Zhe-Wei Wei
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Correspondence to Yu-Long He or Chang-Hua Zhang.

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Zhe-Wei Wei and Jia-Ling Li have contributed equal to this work.

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Wei, ZW., Li, JL., Wu, Y. et al. Impact of Pre-existing Type-2 Diabetes on Patient Outcomes After Radical Resection for Gastric Cancer: A Retrospective Cohort Study. Dig Dis Sci 59, 1017–1024 (2014). https://doi.org/10.1007/s10620-013-2965-6

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  • DOI: https://doi.org/10.1007/s10620-013-2965-6

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