Clinical Science
The role of diabetes and other co-morbidities on survival after esophageal cancer surgery in a population-based study

https://doi.org/10.1016/j.amjsurg.2013.01.035Get rights and content

Abstract

Background

There is limited knowledge on how diabetes and other comorbidities influence the survival of patients undergoing curative esophageal cancer surgery.

Methods

A population-based and prospective cohort study included patients who underwent surgical resection for esophageal or cardia cancer in Sweden from 2001 to 2005, with follow-up until 2011. Associations between diabetes and other comorbidities in relation to postoperative mortality were analyzed using Cox proportional-hazards regression with adjustment for potential confounding factors.

Results

Among 609 patients, 67 (11%) with diabetes had no increased risk for mortality compared with those without diabetes (hazard ratio, .81; 95% confidence interval, .60 to 1.09). Compared with patients without any predefined comorbidities, those with 1 (hazard ratio, 1.15; 95% confidence interval, .93 to 1.43) or ≥2 comorbidities (hazard ratio, 1.05; 95% confidence interval, .83 to 1.33) had no statistically significantly increased risk for mortality.

Conclusions

This study revealed no strongly increased risk for mortality in patients with diabetes or other comorbidities selected for esophageal cancer surgery.

Section snippets

Study design

This was a nationwide, Swedish, population-based prospective cohort study of patients diagnosed with esophageal or esophagogastric junctional cancer who underwent curative esophageal resection from April 2, 2001, to December 31, 2005, with follow-up until death or the end of the study period (May 31, 2011). Informed consent was obtained from all participating patients, and the Regional Ethical Review Board in Stockholm, Sweden, approved the study.

Data collection

Data were collected from the prospective Swedish

Patient characteristics

A total of 616 patients were included in the database, representing 90% of all eligible patients in the study base. Because of missing data on tumor stage in 6 patients and missing histology in 1 patient, the final analyses were performed on 609 patients (99%). Characteristics of patients with and without diabetes and other comorbidities are presented in Table 1. Diabetes was found in 67 patients (11%). Patients with diabetes were older than those without comorbidities. Also, patients with

Comments

This study indicates that neither the presence of diabetes nor the comorbidities of cardiovascular disease, hypertension, and pulmonary disease increase mortality after esophageal cancer surgery.

Diabetes has recently been reported to increase the risk for mortality in patients with cancer in general14 and after colorectal cancer surgery in particular.15, 16 Two previous studies have found that the presence of diabetes is associated with an increased risk for 30-day mortality after esophageal

References (20)

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Cited by (17)

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    This result is identical to those of previous studies [27,29]. In contrast, Backemar et al. showed that comorbidity had no association with OS in oesophageal cancer [30]. In their study, 16% of the patients had undergone only a gastrectomy instead of an oesophageal resection.

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    However, some studies could not show any negative effect of DM on the prognosis for patients with several other cancers, as in the present study. Backemar et al. found that among 609 patients with esophageal or cardia cancer, 67 with DM had no increased risk for mortality compared with those without DM (HR, 0.81; 95% CI, 0.60–1.09) [17]. Suer et al. evaluated the prognostic value of DM among patients with renal cell carcinoma and could not detect DM as an independent prognostic factor for this tumor [18].

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This project was funded by the Swedish Cancer Society, the Swedish Research Council, the Swedish National Board of Health and Welfare, and the Swedish Society of Medicine.

The authors declare no conflicts of interest.

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