Medical School of Chinese PLA, Beijing, China.
Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
BMC Cancer. 2024 Nov 27;24(1):1461. doi: 10.1186/s12885-024-13232-3.
The objective of this study was to analyze the impact of diabetes mellitus (DM) on short and long term outcomes following radical gastrectomy using propensity score matching (PSM) method, as well as to further investigate the factors influencing patient survival post-radical gastrectomy.
The patients who underwent radical gastrectomy for gastric cancer (GC) between January 2011 and December 2015 were selected as study population, and PSM procedure was conducted with a matching ratio of 1:3 between the DM and non-DM groups. The short-term recovery and long-term survival outcomes were compared between the DM and non-DM group. Subsequently, univariate and multivariate COX regression analyses were conducted to further explore the factors that influence survival outcomes.
Among the cohort of 2508 GC patients who underwent radical surgery prior to PSM, a total of 295 (11.8%) individuals were diagnosed with DM. After conducting 1:3 PSM, 293 DM patients and 821 control patients were enrolled. The results of comparative analysis revealed that the DM group exhibited a significantly higher rate of overall complications (P < 0.001), grade III-V complications (P = 0.010), and prolonged hospitalization (P = 0.001) compared to the control group. However, no statistical difference was observed in survival outcomes between the two groups. Besides, age > 65years (P < 0.001), BMI < 18.5 kg/m (P = 0.001), tumor size > 5 cm (P < 0.001), higher T (P = 0.012) and N tumor stage (P < 0.001), and the occurrence of severe complications (P = 0.007) were identified as independent risk factors for overall survival (OS).
The presence of combined DM in GC patients can heighten the susceptibility to postoperative complications and protract the duration of postoperative recovery, while exerting no significant impact on OS. This study also explored the predictors for OS, thereby providing valuable guidance for the perioperative management and postoperative monitoring.
本研究旨在通过倾向评分匹配（PSM）方法分析糖尿病（DM）对胃癌根治术后短期和长期结局的影响，并进一步探讨影响根治性胃切除术后患者生存的因素。
选取 2011 年 1 月至 2015 年 12 月期间接受胃癌根治术的患者作为研究对象，DM 组和非 DM 组采用 1:3 的匹配比进行 PSM 程序。比较 DM 组和非 DM 组之间的短期恢复和长期生存结局。随后，进行单因素和多因素 COX 回归分析，进一步探讨影响生存结局的因素。
在进行 PSM 前的 2508 例接受根治性手术的 GC 患者队列中，共有 295 例（11.8%）被诊断为 DM。经过 1:3 的 PSM，共纳入 293 例 DM 患者和 821 例对照患者。对比分析结果显示，DM 组的总并发症发生率（P<0.001）、III-V 级并发症发生率（P=0.010）和住院时间延长（P=0.001）均显著高于对照组。然而，两组患者的生存结局无统计学差异。此外，年龄>65 岁（P<0.001）、BMI<18.5kg/m（P=0.001）、肿瘤大小>5cm（P<0.001）、较高的 T（P=0.012）和 N 肿瘤分期（P<0.001）以及严重并发症的发生（P=0.007）被确定为总生存期（OS）的独立危险因素。
GC 患者合并 DM 可增加术后并发症的易感性，并延长术后恢复时间，但对 OS 无显著影响。本研究还探讨了 OS 的预测因素，为围手术期管理和术后监测提供了有价值的指导。
