Preoperative Metabolic Syndrome Is Predictive of Significant Gastric Cancer Mortality after Gastrectomy: The Fujian Prospective Investigation of Cancer (FIESTA) Study

Abstract

Metabolic syndrome (MetS) has been shown to be associated with an increased risk of gastric cancer. However, the impact of MetS on gastric cancer mortality remains largely unknown. Here, we prospectively examined the prediction of preoperative MetS for gastric cancer mortality by analyzing a subset of data from the ongoing Fujian prospective investigation of cancer (FIESTA) study. This study was conducted among 3012 patients with gastric cancer who received radical gastrectomy between 2000 and 2010. The latest follow-up was completed in 2015. Blood/tissue specimens, demographic and clinicopathologic characteristics were collected at baseline. During 15-year follow-up, 1331 of 3012 patients died of gastric cancer. The median survival time (MST) of patients with MetS was 31.3 months, which was significantly shorter than that of MetS-free patients (157.1 months). The coexistence of MetS before surgery was associated with a 2.3-fold increased risk for gastric cancer mortality (P < 0.001). The multivariate-adjusted hazard ratios (HRs) were increased with invasion depth T1/T2 (HR = 2.78, P < 0.001), regional lymph node metastasis N0 (HR = 2.65, P < 0.001), positive distant metastasis (HR = 2.53, P < 0.001), TNM stage I/II (HR = 3.00, P < 0.001), intestinal type (HR = 2.96, P < 0.001), negative tumor embolus (HR = 2.34, P < 0.001), and tumor size ≤ 4.5 cm (HR = 2.49, P < 0.001). Further survival tree analysis confirmed the top splitting role of TNM stage, followed by MetS or hyperglycemia with remarkable discrimination ability. In this large cohort study, preoperative MetS, especially hyperglycemia, was predictive of significant gastric cancer mortality in patients with radical gastrectomy, especially for early stage of gastric cancer.

The fasting blood glucose and long non-coding RNA SNHG8 predict poor prognosis in patients with gastric carcinoma after radical gastrectomy

“…Another large cohort study indicated diabetes was considered as a vital factor in the development of gastric carcinoma [ 10 ]. Moreover, previous FIESTA [ 11 ] had demonstrated hyperglycemia could predict a worse prognosis after radical gastrectomy, especially in the early stage. Appropriately screening methods should be a pivotal part of the clinical management of diabetes patients.…”

Interaction between fasting blood glucose and tumor embolus in predicting the postoperative prognosis of 4330 Chinese patients with gastrointestinal tract cancer

“…The conduct of the current study received approval from the ethical committees of Fujian Provincial Cancer Hospital, and each patient provided written informed consent prior to participation. The detailed design, eligibility criteria and follow-up evaluation have been described elsewhere [7,8].…”

“…We recently in the FIESTA cohort have analyzed a large panel of preoperative factors, and found that elevated fasting blood glucose was an independent and significant predictor for the poor prognosis of postoperative gastric and colorectal cancer, the two major components of gastrointestinal tract cancer Ivyspring International Publisher [7,8]. Both components are clinicopathologically heterogeneous, and tumor embolus is a fatal feature.…”

Factor Analysis of Metabolic Syndrome in Aged Population Undergoing Periodical Health Examinations

“…Diabetic patients with MetS make 4.9 times higher incidence of cardiovascular disease than those without MetS (Montazerifar, Bolouri, Mahmoudi Mozaffar, & Karajibani, 2016). Patients with MetS also have higher risk of colorectal cancer, breast cancer, pancreatic cancer, prostate cancer, and gastric cancer (Hu et al, 2017;Uzunlulu, Telci Caklili, & Oguz, 2016). The prevalence of MetS tends to increase with age.…”