The Relationship between Baseline Fasting Blood Glucose and Tumor Embolus in Predicting the Postoperative Prognosis of 4330 Patients with Gastrointestinal Tract Cancer
22 Pages Posted: 8 Oct 2018More...
Objectives: We aimed to investigate the possible interaction between fasting blood glucose and tumor embolus, and the potential mediation effect of fasting blood glucose on tumor embolus at baseline in predicting gastrointestinal tract cancer-specific mortality risk postoperatively.
Methods: Patients who underwent the surgery were consecutively recruited between January 2000 and December 2010, with annual follow-up ending in December 2015. Total 4330 postoperative patients with complete follow-up information were analyzed.
Results: The median follow-up time was 48.6 months. At the end of follow-up, 1743 deaths from either gastric or colorectal cancer occurred. Survival tree analysis identified two optimal cutoff points for fasting blood glucose (6.11 and 11.69 mmol/L). Patients with fasting blood glucose less than 6.11 mmol/L and negative tumor embolus had the best survival, and contrastingly, the worst survival was seen in patients with fasting blood glucose greater than 11.69 mmol/L and positive tumor embolus. The risk was highest for patients with fasting blood glucose >11.69 mmol/L and positive embolus (adjusted hazard ratio: 11.91, 95% confidence interval: 9.13 to 15.52). Using the Sobel-Goodman mediation test, the proportion of total effect conferred by tumor embolus that was mediated by fasting blood glucose was estimated to be 45.3%.
Conclusions: Our findings indicate a synergistic interaction between fasting blood glucose and tumor embolus at baseline in predicting the postoperative prognosis of gastrointestinal tract cancer. Specifically, fasting blood glucose may serve as a potent mediator and account for about half of effect of tumor embolus on mortality risk.
Funding Statement: This study was financially supported by the Joint Funds for the Innovation of Science and Technology of Fujian Province (Grant No. 2017Y9090 and 2017Y9082), and the Natural Science Foundation of Fujian Province (Grant No. 2018Y0024). The funder of this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Declaration of Interests: The authors declare that they have no conflict of interest.
Ethics Approval Statement: The conduct of the current study received approval from the ethical committees of Fujian Provincial Cancer Hospital, and each patient provided written informed consent prior to participation.
Keywords: gastrointestinal tract cancer; tumor embolus; fasting blood glucose; interaction; prognosis; mortality
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