Preoperative fasting hyperglycemia is an independent prognostic factor for postoperative survival after gallbladder carcinoma radical surgery

Figures & data

Table 1 Clinical and pathologic characteristics of the 83 study patients

Variables	Total (n=83)	Higher glucose levels (n=35)	Normal glucose levels (n=48)	P-value
Sex (n), male/female	23/60	5/30	18/30	0.020
Age (SD), years	66.1 (10.4)	66.4 (11.3)	65.9 (9.9)	0.829
Median body mass index (kg/m^2 [IQR])	22.0 (21.7–22.9)	22.2 (21.3–23.2)	21.9 (21.4–23.2)	0.923
Hemoglobin mean (SD), g/L	120.35 (19.84)	113.40 (17.66)	125.41 (19.98)	0.006
Serum albumin mean (SD), g/L	36.01 (6.10)	34.97 (6.21)	36.77 (5.97)	0.185
NLR [No. (%)]				<0.001
<2.6	43 (51.8)	10 (23.3)	33 (76.7)
≥2.6	40 (48.2)	25 (62.5)	15 (37.5)
Serum CA 19-9 level (U/mL) >37 [No. (%)]				0.309
No	41 (49.4)	15 (36.6)	26 (63.4)
Yes	42 (50.6)	20 (47.6)	22 (52.4)
Serum CEA level (ng/mL) >5 [No. (%)]				0.002
No	54 (65.1)	16 (29.6)	38 (70.4)
Yes	29 (34.9)	19 (65.5)	10 (34.50)
T [No. (%)]				0.001
I–II	27 (32.5)	4 (14.8)	23 (85.2)
III–IV	56 (67.5)	31 (55.4)	25 (44.6)
Gallstones [No. (%)]				0.255
No	44 (53.0)	16 (36.4)	28 (63.6)
Yes	39 (47.0)	19 (48.7)	20 (51.3)
Tumor size (cm) >3 [No. (%)]				0.002
No	40 (48.2)	10 (25.0)	30 (75.0)
Yes	43 (51.8)	25 (58.1)	18 (41.9)
Differentiation of GBC [No. (%)]				0.073
Poor/unknown	55 (66.3)	27 (49.1)	28 (50.9)
Well/moderate	28 (33.7)	8 (28.6)	20 (71.4)
TNM stage [No. (%)]				0.002
I–II	27 (32.5)	5 (18.5)	22 (81.5)
III–IV	56 (67.5)	30 (53.6)	26 (46.4)
Lymph node metastases [No. (%)]				<0.001
No	45 (54.2)	10 (22.2)	35 (77.8)
Yes	38 (45.8)	25 (65.8)	13 (34.2)

Note: Variables in bold are statistically significant (P<0.05).

Abbreviations: CEA, carcinoembryonic antigen; GC, gallbladder carcinoma; NLR, neutrophil-to-lymphocyte ratio.

Figure 1 The overall survival rate of GBC patients after GBC radical surgery.

Notes: The Kaplan–Meier curve showed significant differences in the probability of total survival after GBC radical surgery in patients with preoperative fasting hyperglycemia and preoperative fasting normal blood glucose levels. P<0.001 (log-rank test).

Abbreviation: GC, gallbladder carcinoma.

Figure 2 RFS of patients with GBC after GBC radical surgery.

Notes: Kaplan–Meier curves show significant differences in RFS probability after GBC radical surgery in patients with preoperative fasting hyperglycemia and preoperative fasting normal blood glucose levels. P<0.001 (log-rank test).

Abbreviations: GC, gallbladder carcinoma; RFS, recurrence-free survival.

Table 2 Univariate and multivariate analyses of prognostic factors associated with overall survival

Variables	Univariate analysis		Multivariate analysis
	HR (95% CI)	P-value	HR (95% CI)	P-value
Age	1.023 (0.996–1.050)	0.094
Sex female	0.857 (0.464–1.585)	0.623
Body mass index	0.979 (0.888–1.080)	0.676
Serum albumin (g/L)	0.930 (0.889–0.972)	0.001	0.942 (0.895–0.992)	0.022
Serum CA 19-9 (U/mL) >37	2.204 (1.526–3.868)	0.006
Serum CEA (ng/mL) >5	1.700 (0.782–2.943)	0.058
Hemoglobin	0.990 (0.977–1.004)	0.155
NLR >2.6	2.126 (1.228–3.280)	0.007
Gallstones	1.513 (0.881–2.598)	0.134
Tumor size >3 cm	1.643 (0.945–2.854)	0.078
T III–IV	2.667 (1.401–5.116)	0.003
Poor differentiation	0.305 (0.155–0.599)	0.001	0.233 (0.107–0.508)	<0.001
Lymph node metastases	2.047 (1.182–3.545)	0.011
TNM stage III + IV	8.108 (3.203–20.22)	<0.001	8.024 (2.635–24.439)	<0.001
Hyperglycemia	3.215 (1.846–5.601)	<0.001	2.832 (1.480–5.418)	0.002

Note: Variables in bold are statistically significant in multivariate analysis (P<0.05). Abbreviation: NLR, neutrophil-to-lymphocyte ratio.

Table 3 Univariate and multivariate analyses of prognostic factors associated with RFS

Variables	Univariate analysis		Multivariate analysis
	HR (95% CI)	P-value	HR (95% CI)	P-value
Age	1.017 (0.992–1.043)	0.180
Sex female	0.709 (0.389–1.292)	0.216
Body mass index	0.976 (0.890–1.070)	0.604
Serum albumin (g/L)	0.933 (0.893–0.975)	0.002
Serum CA 19-9 (U/mL) >37	2.414 (1.421–4.101)	0.001
Serum CEA (ng/mL) >5	1.573 (0.919–2.694)	0.099
Hemoglobin	0.998 (0.976–1.001)	0.068
NLR >2.6	2.014 (1.192–3.403)	0.009
Gallstones	1.271 (0.760–2.126)	0.360
Tumor size >3 cm	1.381 (0.825–2.309)	0.219
T III–IV	2.299 (1.274–4.150)	0.006
Poor differentiation	0.297 (0.159–0.556)	<0.001	0.277 (0.137–0.560)	<0.001
Lymphonodus metastasis	1.829 (1.094–3.057)	0.021
TNM stage III + IV	4.165 (2.161–8.026)	<0.001	3.140 (1.444–6.828)	0.004
Hyperglycemia	2.644 (1.562–4.474)	<0.001	2.051 (1.127–3.733)	0.019

Note: Variables in bold are statistically significant in multivariate analysis (P<0.05).

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; RFS, recurrence-free survival.