Li Mu-Xing, Lopez-Aguiar Alexandra G, Poultsides George, Rocha Flavio, Weber Sharon, Fields Ryan, Idrees Kamran, Cho Cliff, Maithel Shishir K, Zhang Xu-Feng, Pawlik Timothy M
Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of General Surgery, Peking University Third Hospital, Beijing, China.
J Surg Oncol. 2025 Mar;131(3):473-480. doi: 10.1002/jso.27951. Epub 2024 Oct 10.
To investigate the impact of preoperative glycosylated hemoglobin A1C (HbA1c) among patients following curative-intent resection of nonfunctional gastroentropancreatic neuroendocrine tumors (GEP-NETs).
Patients who underwent curative-intent resection for GEP-NETs from 2000 to 2020 were identified from the US Neuroendocrine Tumor Study Group (US-NETSG). Preoperative blood HbA1c levels were defined as high HbA1c (≥ 6.5%) versus low HbA1c group (< 6.5%). Impact of HbA1c level on postoperative short-term and long-term overall (OS) were investigated.
A total of 130 patients with HbA1c < 6.5% and 60 patients with HbA1c ≥ 6.5% were included. Patients with HbA1c ≥ 6.5% had higher proportion of comorbidities, such as hypertension, obesity, anemia, and lower preoperative albumin levels versus patients with HbA1c < 6.5% (all p < 0.05). In addition, high level of preoperative HbA1c was associated with increased incidence of wound and infectious complications, as well as decreased long-term OS (median OS: high Hb1Ac 89.8 months vs. low Hb1Ac not reached, HR 3.487, p = 0.004) among patients with nonfunctional GEP-NETs, as well as among the subset of pancreatic NET patients (median OS: high Hb1Ac 74.3 months vs. low Hb1Ac not reached, p = 0.004), and patients with normal fasting blood glucose (< 140 mg/dL) (median OS: high Hb1Ac 75.4 months vs. low Hb1Ac not reached, p = 0.001).
Hb1Ac might have value as a screening tool to identify high-risk patients following surgical resection of nonfunctional GEP-NETs for consideration of more strict postoperative surveillance and treatment of elevated Hb1Ac level.
探讨术前糖化血红蛋白A1C（HbA1c）对无功能性胃肠胰神经内分泌肿瘤（GEP-NETs）行根治性切除术后患者的影响。
从美国神经内分泌肿瘤研究组（US-NETSG）中确定2000年至2020年接受GEP-NETs根治性切除的患者。术前血液HbA1c水平分为高HbA1c（≥6.5%）组和低HbA1c组（<6.5%）。研究HbA1c水平对术后短期和长期总体生存率（OS）的影响。
共纳入130例HbA1c<6.5%的患者和60例HbA1c≥6.5%的患者。与HbA1c<6.5%的患者相比，HbA1c≥6.5%的患者合并症比例更高，如高血压、肥胖、贫血，且术前白蛋白水平更低（所有p<0.05）。此外，术前高HbA1c水平与无功能性GEP-NETs患者、胰腺NET患者亚组以及空腹血糖正常（<140mg/dL）患者的伤口和感染并发症发生率增加以及长期OS降低相关（中位OS：高Hb1Ac为89.8个月，低Hb1Ac未达到，HR 3.487，p=0.004），胰腺NET患者亚组（中位OS：高Hb1Ac为74.3个月，低Hb1Ac未达到，p=0.004），空腹血糖正常患者（中位OS：高Hb1Ac为75.4个月，低Hb1Ac未达到，p=0.001）。
Hb1Ac可能作为一种筛查工具，用于识别无功能性GEP-NETs手术切除后的高危患者，以便考虑更严格的术后监测和Hb1Ac水平升高的治疗。
