[Prognosis analysis of patients with locally advanced gastric cancer complicated with diabetes].

Objective: To investigate the clinicopathological characteristics, perioperative complications, and survival prognosis of patients with locally advanced gastric cancer complicated with diabetes mellitus (DM). Methods: A retrospective cohort study was conducted. Inclusion criteria: (1) local advanced gastric adenocarcinoma confirmed by postoperative pathology; (2) radical gastrectomy for gastric cancer (R0 resection); (3) follow-up time of at least 36 months. Exclusion criteria: (1) preoperative neoadjuvant chemotherapy, radiotherapy, chemoradiotherapy, or immunotherapy; (2) remnant gastric cancer; (3) distant metastasis; (4) severe autoimmune disease; (5) other malignant tumors; (6) severe organic heart, lung, or renal diseases; (7) incomplete clinicopathological or follow-up data. According to the above criteria, clinicopathological data of 1552 patients with locally advanced gastric cancer who underwent radical gastrectomy at the Gastric Cancer Center, West China Hospital, Sichuan University between January 2010 and December 2020 were collected. Patients were divided into a DM group and a non-DM group according to preoperative DM status. A 1:1 propensity score matching (PSM) was performed to control for confounding factors including age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, TNM stage and tumor location. After PSM, 162 patients were included in each group. Baseline characteristics were well balanced between the two groups (all P > 0.05). The primary endpoint was overall survival (OS), and the secondary outcomes were intraoperative and postoperative parameters. Results: After PSM, the DM group had longer operative time [(251.4±61.3) minutes vs. (227.4±51.7) minutes, t=-3.81, P<0.001], greater intraoperative blood loss [100 (30-150) ml vs. 80 (20-100) ml, Z=-2.17, P=0.030], longer total hospital stay [(18.2±9.9) days vs. (16.1±7.0) days, t=-2.20, P=0.024], and longer postoperative hospital stay [(11.6±6.6) days vs. (10.2±4.5) days, t=-2.23, P=0.029]. However, there were no significant differences in 30-day postoperative mortality, or perioperative complication rate (all P > 0.05). There was also no significant difference in OS between the two groups (median OS in DM group: not reached (74.0-not reached) months vs non-DM group: 105.7(87.5-not reached) months,P=0.865). Multivariate Cox regression analysis showed that DM was not independently associated with OS (P = 0.767), while advanced TNM stage (stage III vs stage I: HR = 3.974, 95%CI: 1.842-8.571, P < 0.001) and tumor location (gastric antrum vs. gastric fundus/esophagogastric junction: HR=0.652, 95%CI: 0.454-0.936, P=0.020) were independent risk factors for OS. Conclusion: Among patients with locally advanced gastric cancer undergoing radical surgery, those with DM have longer operative time, greater intraoperative blood loss, longer total hospital stay, and longer postoperative hospital stay. However, 30-day postoperative mortality, perioperative complication rate and long-term prognosis are comparable to those without DM.