The elevated preoperative fasting blood glucose predicts a poor prognosis in patients with esophageal squamous cell carcinoma: The Fujian prospective investigation of cancer (FIESTA) study

Abstract

Diabetes as a latent risk factor for cancer has been extensively investigated, while its postoperative prognosis for esophageal cancer is rarely reported. We therefore sought to assess whether the elevated fasting blood glucose before surgery was associated with poor survival in esophageal cancer patients by eliciting a subset of data from the ongoing Fujian prospective investigation of cancer (FIESTA) study. Over 15-year follow-up, 2535 patients receiving three-field lymphadenectomy were assessable. Only patients with esophageal squamous cell carcinoma (ESCC) (n=2396) were analyzed due to the lower prevalence of the other histological types. In ESCC patients, the follow-up duration ranged from 0.5 to 180 months (median 38.2 months). The median survival time (MST) was remarkably shorter in males than in females (80.7 vs. 180+ months, Log-rank test: P<0.001). In males, the survival was worse in patients with diabetes than those without (MST: 27.9 vs. 111.1 months, Log-rank test: P<0.001). In females, the survivor was improved in patients with diabetes (MST: 71.5 months), but was still worse than patients without diabetes (MST: 180+ months, Log-rank test: P<0.001). The overall multivariate hazard ratio for per unit increment in fasting blood glucose was 1.11 (95% confidence interval or CI: 1.09-1.14, P<0.001) and 1.08 (95% CI: 1.03-1.13, P=0.002) in males and females, respectively. Further survival tree analysis consolidated the discrimination ability of fasting blood glucose for the survival of ESCC patients. Taken together, our findings convincingly demonstrated that the elevated preoperative fasting blood glucose can predict poor survival of ESCC patients, especially in males.

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

“…The FIESTA study initiated in January 2000 is an ongoing prospective cohort study of common digestive system tumors, including esophageal cancer, gastric cancer and colorectal cancer (Hu et al, 2016a, Peng et al, 2016, Hu et al, 2016b), and the purport of this study is to identify preoperative prognostic risk factors for cancer-specific mortality, which will help pinpoint underlying targets to delay tumor progression and prolong the survival of cancer patients after surgery. The conduct of this FIESTA study was approved by the Ethics Committee of Fujian Provincial Cancer Hospital and informed consent was obtained from all participants.…”

Baseline Metabolic Risk Score and Postsurgical Esophageal Cancer-Specific Mortality: The Fujian Prospective Investigation of Cancer (FIESTA) Study

“…As a part of FIESTA study 9 - 15 , the current study involved 2886 EC patients who were consecutively admitted at Department of Thoracic Surgery, Fujian Cancer Hospital to receive three-field lymphadenectomy for the first time, and were safely discharged after the surgery during the period between January 2000 and December 2010. At the time of recruitment, all patients gave written informed consent for use of blood and tissue samples, as well as subsequent analyses.…”

“…Metabolic syndrome represents a clustering of cardiovascular risk factors, including obesity, dysglycemia, elevated blood pressure, high circulating triglyceride (TG) and low circulating high-density lipoprotein cholesterol (HDLC). More recently, we in an ongoing prospective cohort study - the Fujian prospective investigation of cancer (FIESTA) study 9 - 15 , have assessed the prediction of baseline metabolic syndrome and its components for cancer specific mortality of common digestive malignancies. Importantly, our findings have demonstrated that the concomitance of baseline metabolic syndrome was identified as a significant independent predictor for high ESCC-specific mortality after three-field lymphadenectomy.…”

Interaction Between Prediabetes and the ABO Blood Types in Predicting Postsurgical Esophageal Squamous Cell Carcinoma-Specific Mortality: The FIESTA Study

“…The FIESTA study is an ongoing investigation of preoperative factors for predicting disease-specific mortality of common digestive tract cancer, including sites at esophagus, stomach and colon and rectum ( 4 , 15 – 24 ). The study proposal was approved by Ethics Committee of Fujian Provincial Cancer Hospital (the current Fujian Cancer Hospital and Fujian Medical University Cancer Hospital).…”