围术期高血糖与食管切除术后食管鳞癌不良预后相关性OA

Objective: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.Methods: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 hyper-glycemia 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 postopera-tive 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.Results: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 hyper-glycemia 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 hy-perglycemia 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 mor-tality risk(HR=1.86,95％CI:1.49-2.32).Stratified analysis revealed that BMI significantly modi-fied the association between hyperglycemia and adverse prognosis(Pinteraction=0.010),with the associa-tion being particularly pronounced in patients with BMI ≥24.0 kg/n2.Additionally,perioperative hy-perglycemia was associated with poorer short-term postoperative outcomes.Conclusion:Perioperative hy-perglycemia 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.