[Perioperative hyperglycemia predicts poorer prognosis of esophageal squamous cell carcinoma patients treated with esophagectomy].

Authors

Bo Peng, Fangfang Liu, Wei Yang, Ruiping Xu, Lei Chen, Baozhong Li, Xinjia Wang, Ji Ke, Wenlei Yang, Yu He, Zhen Liu, Bolin Hou, Liqun Zhang, Miaoping Lin, Lixin Zhang, Fan Zhang, Fen Cai, Huawen Xu, Mengfei Liu, Ying Liu, Yaqi Pan, Zhonghu He, Yang Ke

Published in

Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences. Volume 58. Issue 3. Pages 567-574. Jun 18, 2026.

Abstract

To systematically evaluate the association between perioperative hyperglycemia and postoperative prognosis in esophageal squamous cell carcinoma (ESCC) patients using large-scale, multicenter real-world data.
A total of 5 952 patients with ESCC who underwent radical esophagectomy were consecutively included in this retrospective cohort study from the Anyang Cancer Hospital in Anyang, Henan Province (January 2012 to December 2017) and the Cancer Hospital of Shantou University Medical College in Shantou, Guangdong Province (August 2009 to December 2018). Perioperative fasting glucose data were obtained from the hospital information system. The perioperative period was divided into preoperative and postoperative phases: Preoperative hyperglycemia was defined as a mean fasting glucose level ≥7.0 mmol/L from day 14 to day 2 before surgery, and postoperative hyperglycemia was defined as a mean fasting glucose level ≥7.0 mmol/L from day 2 to day 14 after surgery. The primary outcome was overall survival (OS), and secondary outcomes included 30 d/90 d postoperative mortality and in-hospital complications. Multivariable Cox proportional hazards models were used to assess the association between perioperative hyperglycemia and OS, with adjusted hazard ratios (HR) and 95% confidence intervals (CI) calculated.
The maximum follow-up period was 12 years. The prevalence of preoperative and postoperative hyperglycemia was 6.7% and 18.3%, respectively. Patients with preoperative hyperglycemia had a lower 5-year OS rate than those without (57.3% vs. 65.0%), with an adjusted HR of 1.41 (95%CI: 1.19-1.68). The patients with postoperative hyperglycemia also had reduced 5-year survival (61.8% vs. 66.4%), with an adjusted HR of 1.39 (95%CI: 1.22-1.58). Joint analysis showed that compared with patients without hyperglycemia, those with hyperglycemia in either the preoperative or postoperative phase alone had an elevated mortality risk (HR=1.24, 95%CI: 1.07-1.43), while the patients with hyperglycemia in both phases had the highest mortality risk (HR=1.86, 95%CI: 1.49-2.32). Stratified analysis revealed that BMI significantly modified the association between hyperglycemia and adverse prognosis (P_interaction=0.010), with the association being particularly pronounced in patients with BMI ≥24.0 kg/m². Additionally, perioperative hyperglycemia was associated with poorer short-term postoperative outcomes.
Perioperative hyperglycemia is an independent risk factor for long-term survival in ESCC patients undergoing curative esophagectomy. These findings suggest that enhanced routine glucose monitoring and control during perioperative management of ESCC may help improve long-term patient outcomes.

PMID:
42287052
Bibliographic data and abstract were imported from PubMed on 13 Jun 2026.

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