Preoperative hyperglycemia as an independent predictor of reduced long-term survival after gastric cancer surgery.

OBJECTIVE

While hyperglycemia is known to influence long-term outcomes in various malignancies, this study specifically investigates its association with overall survival after gastric cancer surgery.

METHODS

This study included 1109 patients who underwent gastric cancer resection with curative intent at the Sixth Affiliated Hospital of Sun Yat-Sen University between January 2018 and December 2021. Patients were divided into hyperglycemia and non-hyperglycemia groups with preoperative fasting blood glucose (FBG) cut-off value of 126 mg/dL. Cox regression analysis and Kaplan-Meier survival curves were then employed to assess the relationship between hyperglycemia and overall survival (OS) in the entire cohort. Finally, a subgroup analysis was conducted to further explore these associations.

RESULTS

Among the 1109 patients, 121 (10.9%) were hyperglycemia and 988 (89.1%) were non-hyperglycemia. The 5-year overall survival rate was significantly lower in the hyperglycemia group compared to the non-hyperglycemia group (41.3% vs. 64.9%, P < 0.001). Kaplan-Meier survival curves indicated a significantly increased risk of mortality in hyperglycemia patients (log rank, P < 0.001). After adjustment, hyperglycemia remained independently associated with worse survival (adjusted Hazard Ratio: 1.74, 95% CI 1.31-2.32).

CONCLUSION

Preoperative hyperglycemia (FBG ≥ 126 mg/dL) is an independent risk factor for reduced long-term survival in gastric cancer patients, underscoring the critical importance of perioperative glycemic control as a key modifiable factor to improve surgical outcomes.