title: 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.
authors.affiliation: Department of Pathology, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Hu
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Peng
authors.affiliation: Department of Pathology, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Xiandong
authors.initials: X
authors.lastname: Lin
authors.affiliation: Department of Pathology, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Chen
authors.affiliation: Medical-Record Department, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Binying
authors.initials: B
authors.lastname: Liang
authors.affiliation: Department of Pathology, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Pathology, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Hejun
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Pathology, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Xuehong
authors.initials: X
authors.lastname: Liao
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Jinxiu
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Pathology, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Xiongwei
authors.initials: X
authors.lastname: Zheng
authors.affiliation: State Key Laboratory of Medical Genomics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Wenquan
authors.initials: W
authors.lastname: Niu
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose; D002294:Carcinoma, Squamous Cell / Q000097:blood* / Q000401:mortality*; D015331:Cohort Studies; D048909:Diabetes Complications / Q000401:mortality*; D003920:Diabetes Mellitus; D004938:Esophageal Neoplasms / Q000097:blood* / Q000401:mortality*; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis
chemical_list: D001786:Blood Glucose
keywords: FIESTA study; esophageal squamous cell carcinoma; fasting blood glucose; mortality; prognosis