Background: Lung cancer patients have a high frequency of comorbidity. The diabetes mellitus (DM) has been reported to be associated with postoperative complication and survival in several types of cancers. The aim of this study was to...
moreBackground: Lung cancer patients have a high frequency of comorbidity. The diabetes mellitus (DM) has been reported to be associated with postoperative complication and survival in several types of cancers. The aim of this study was to investigate the impact of DM on postoperative complication and survival in operable nonsmall cell lung cancer (NSCLC) patients. Method: We retrospectively reviewed 1231 patients who underwent surgical resection for NSCLC between 1996 and 2012. The outcomes were compared between the patients with DM (DM group, n¼139) and without it (Non-DM group, n¼1092). Patients were assigned to DM group if following conditions were identified; 1) a history of DM or medication use, and 2) preoperatively elevated fasting glucose (>126 mg/dL) or hemoglobin A1c (National Glycohemoglobin Standardization Program) level (6.5 %) in spite of the unrevealed history of DM. However, diabetes of all patients in DM group was controlled by dietary or sliding-scale insulin therapy. Postoperative complications were defined as events of grade 2 or more according to the Clavien-Dindo classification. A multivariate Logistic regression model was used to identify clinical factors associated with postoperative complication. Survival was evaluated by overall, relapse-free, and disease-specific survivals using Kaplan-Meier method, and a multivariate Cox proportional hazard model was used to identify prognostic factors. Result: DM group included more elderly patients, males, smokers, patients with ischemic heart disease, patients taking antiplatelet or anticoagulant drugs, squamous cell carcinomas than non-DM group. DM group showed higher incidence of postoperative complications than non-DM group (28% vs. 21%, p¼0.047). Logistic regression analysis showed that DM was an independent predictor for postoperative complication (OR: 1.851, 95% CI: 1.189-2.884). But, no significant difference was observed in thirty-day mortality between the two groups (2% vs. 1%, p¼0.061). DM group showed a worse overall survival than non-DM group (p¼0.024), and multivariate Cox analysis showed that DM was identified as an independent poor prognostic factor for overall survival (HR: 1.492, 95% CI: 1.053-2.113). DM group included more death from other disease than non-DM group (50% vs. 35%, p¼0.048), and there was no significant difference in relapse-free and disease-specific survival between the two groups. Conclusion: The present study demonstrated that operable NSCLC patients with DM have distinct clinicopathological features. Although the presence of preoperative DM was associated with postoperative morbidity and worse overall survival, it did not increase perioperative and lung cancer-related mortalities. Operable NSCLC patients with DM can be still indicated for curative surgery if their perioperative diabetes was controlled.
