Impact of Pre-existing Type-2 Diabetes on Patient Outcomes After Radical Resection for Gastric Cancer: A Retrospective Cohort Study
Impact of Pre-existing Type-2 Diabetes on Patient Outcomes After Radical Resection for Gastric Cancer: A Retrospective Cohort Study
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既往患有 2 型糖尿病对胃癌根治术后患者预后的影响：一项回顾性队列研究
DOI：
10.1007/s10620-013-2965-6
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发表时间：
2014-05-01
影响因子：
3.1
通讯作者：
Zhang, Chang-Hua
中科院分区：
文献类型：
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作者：
Wei, Zhe-Wei;Li, Jia-Ling;Zhang, Chang-Hua
本研究的目的是评估既往存在的2型糖尿病对接受根治性胃切除术的胃癌（GC）患者术后恢复和预后的影响，从2001年6月至2011年6月，共纳入1，014例符合条件的患者。其中，67例患者被诊断为2型糖尿病。比较2型糖尿病患者（DM组）与非糖尿病患者（非DM组）的临床病理特征和预后数据，中位生存期为68.3个月。DM组的5年总生存率与非DM组相似（52.1% vs. 53.0%，p = 0.411）。倾向评分匹配分析表明，与非DM组相比，DM组的死亡风险比为1.191（95%置信指数0.693-2.072; p = 0.531）。DM组的术后并发症发生率高于非DM组（17.9 vs. 8.1%，p = 0.006）。在接受Roux-en-Y重建的患者中，DM缓解率为46%，在接受Billroth II吻合术的患者中为13%（p = 0.009）。糖尿病治愈或好转患者的5年总生存率为62.1%，糖尿病恶化或相同患者的5年总生存率为23.4%（p = 0.003）。先前存在的糖尿病与术后并发症的增加和生存率的降低有关，当GC根治性切除后病情恶化时。
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.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).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).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.