J Cancer 2020; 11(4):867-873. doi:10.7150/jca.34843

Research Paper

Interaction between fasting blood glucose and tumor embolus in predicting the postoperative prognosis of 4330 Chinese patients with gastrointestinal tract cancer

Dan Hu1*, Xinran Zhang2*, Xiandong Lin3, Hejun Zhang1, Yan Xia1, Jinxiu Lin4, Xiongwei Zheng1, Feng Peng4✉, Wenquan Niu2✉

1. Department of Pathology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China.
2. Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China.
3. Department of Radiobiology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China.
4. Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
*Shared first authors.

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Citation:
Hu D, Zhang X, Lin X, Zhang H, Xia Y, Lin J, Zheng X, Peng F, Niu W. Interaction between fasting blood glucose and tumor embolus in predicting the postoperative prognosis of 4330 Chinese patients with gastrointestinal tract cancer. J Cancer 2020; 11(4):867-873. doi:10.7150/jca.34843. Available from http://www.jcancer.org/v11p0867.htm

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Abstract

Objectives: We aimed to investigate the interaction between fasting blood glucose and tumor embolus, and the potential mediation effect of fasting blood glucose on tumor embolus in predicting gastrointestinal tract cancer-specific mortality risk postoperatively.

Methods and Results: 4330 patients were consecutively recruited between January 2000 and December 2010, with annual follow-up ending in December 2015. The median follow-up time was 48.6 months. Two optimal cutoff points for fasting blood glucose (6.11 and 11.69 mmol/L) were identified. Patients with fasting blood glucose <6.11 mmol/L and negative tumor embolus had the best survival, and the worst survival was seen in patients with fasting blood glucose >11.69 mmol/L and positive tumor embolus. The risk was highest for patients with fasting blood glucose >11.69 mmol/L and positive tumor embolus (adjusted HR: 11.91, 95% CI: 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 in predicting the postoperative prognosis of gastrointestinal tract cancer.

Keywords: gastrointestinal tract cancer, tumor embolus, fasting blood glucose, interaction, prognosis, mortality