Journal
EBIOMEDICINE
Volume 16, Issue -, Pages 115-123Publisher
ELSEVIER
DOI: 10.1016/j.ebiom.2017.01.035
Keywords
Esophageal squamous cell carcinoma; Metabolic syndrome; Metabolic risk factors; FIESTA study; Prognosis; Mortality
Funding
- Natural Science Foundation of Fujian Province [2015J01451, 2016J01508, 2016J01513]
- Training Project for Young and Middle-Aged Core Talents of Health System of Fujian Province [2015-ZQN-JC-7, 2015-ZQN-JC-22]
- Science and Technology Plan Projects of Fujian Province [2014Y0019]
- National Clinical Key Specialty Construction Program of China [2013-544]
- Ministry of Health of the People's Republic of China [WKJ2016-2-05]
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Some metabolic factors have been shown to be associated with an increased risk of esophageal cancer; however the association with its prognosis is rarely reported. Here, we assessed the prediction of preoperative metabolic syndrome and its single components for esophageal cancer mortality by analyzing a subset of data from the ongoing Fujian prospective investigation of cancer (FIESTA) study. Between 2000 and 2010, patients who underwent three-field lymphadenectomy were eligible for inclusion. Blood/tissue specimens, demographic and clinicopathologic data were collected at baseline. Metabolic syndrome is defined by the criteria proposed by Chinese Diabetes Society. In this study, analysis was restricted to esophageal squamous cell carcinoma (ESCC) due to the limited number of other histological types. The median follow-up in 2396 ESCC patients (males/females: 1822/574) was 38.2 months (range, 0.5-180 months). The multivariate-adjusted hazard ratio (HR) of metabolic syndrome for ESCC mortality was statistically significant in males (HR, 95% confidence interval, P: 1.45, 1.14-1.83, 0.002), but not in females (1.46, 0.92-2.31, 0.107). For single metabolic components, the multivariate-adjusted HRs were significant for hyperglycemia (1.98, 1.68-2.33, <0.001) and dyslipidemia (1.41, 1.20-1.65, <0.001) in males and for hyperglycemia (1.76, 1.23-2.51, <0.001) in females, independent of clinicopathologic characteristics and obesity. In tree-structured survival analysis, the top splitting factor in both genders was tumor-node-metastasis stage, followed by regional lymph node metastasis. Taken together, our findings demonstrate that preoperative metabolic syndrome was a significant independent predictor of ESCC mortality in males, and this effect was largely mediated by glyeolipid metabolism disorder. (C) 2017 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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