Wei Zhe-Wei, Li Jia-Ling, Wu Ying, Xia Guang-Kai, Schwarz Roderich E, He Yu-Long, Zhang Chang-Hua
Department of Gastrointestinopancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
Dig Dis Sci. 2014 May;59(5):1017-24. doi: 10.1007/s10620-013-2965-6. Epub 2013 Dec 8.
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.
本研究旨在评估术前存在的2型糖尿病对接受根治性胃切除术的胃癌（GC）患者术后恢复及预后的影响。
2001年6月至2011年6月，共纳入1014例符合条件的患者。其中，67例被诊断为2型糖尿病。比较2型糖尿病患者（糖尿病组）和非糖尿病患者（非糖尿病组）的临床病理特征及预后数据。
中位生存期为68.3个月。糖尿病组的5年总生存率与非糖尿病组相似（52.1%对53.0%，p = 0.411）。倾向评分匹配分析显示，与非糖尿病组相比，糖尿病组的死亡风险比为1.191（95%置信区间0.693 - 2.072；p = 0.531）。糖尿病组术后并发症的发生率高于非糖尿病组（17.9%对8.1%，p = 0.006）。接受Roux - en - Y重建的患者中糖尿病缓解率为46%，接受毕罗Ⅱ式吻合术的患者中为13%（p = 0.009）。糖尿病治愈或改善的患者5年总生存率为62.1%，糖尿病状态恶化或不变的患者为23.4%（p = 0.003）。
在部分GC患者中，根治性胃切除术加Roux - en - Y重建可治愈2型糖尿病。术前存在的糖尿病与术后并发症增加及GC根治性切除术后病情恶化时生存率降低有关。
