Impact of diabetes mellitus and perioperative intensive blood glucose control on postoperative complications and long -term outcome in non-small cell lung cancer

Background

Diabetes mellitus (DM) is a major disease that may influence survival outcomes and the incidence of postoperative complications in patients with non-small cell lung cancer (NSCLC). However, the effects of DM on survival and postoperative complications have not yet been investigated. We aimed to elucidate the surgical outcomes and impact of perioperative intensive glucose control (IC) in patients with DM.

Methods

This study included NSCLC patients who underwent curative resection at a single institution between 2013 and 2017. DM was confirmed in patients treated by referral doctors or in those with HbA1c< 6.5 % without medication. At our institution, IC is performed in many patients with DM.

Results

A total of 854 patients were recruited: 163 in the DM and 691 in the non-DM groups. Multivariate analysis revealed DM was associated with poor recurrence-free survival (HR, 1.37; P = .046, respectively) and tended to be associated with overall survival (HR, 1.43; P = .077). The incidence of postoperative complications did not differ between the DM and non-DM groups (P = .73). However, 90-day mortality was significantly higher in the DM group (3/163 vs. 0/691, P = .007). In patients with DM, IC was independently associated with the incidence of postoperative complications (P = .042).

Conclusions

Our results suggest that DM is a prognostic predictor of poor overall survival and relapse-free survival. IC may reduce postoperative complications in patients with DM. Preoperative assessment and perioperative glycemia control for DM patients may be important for those with surgically treated NSCLC.