Study On Effect Of Visceral Adipose Tissue Index On Postoperative Blood Glucose,Complications And Long-Term Prognosis In Patients With Non-Diabetic Gastric Cancer

Objective:To investigate the influence of visceral adipose tissue index(VATI)on blood glucose(BG),short-term complications and long-term survival of patients with non-diabetic gastric cancer(GC)during supplementary parenteral nutrition(SPN)after radical resection.Methods:A retrospective analysis was conducted on 218 patients with stage I～III GC who underwent radical gastrectomy and SPN from January 2018 to April 2021 in the Oncology Department,the First Hospital of Lanzhou University.The VATI was calculated according to the visceral fat area of the third lumbar vertebral level on preoperative CT,and the patients were divided into three groups:low visceral adipose tissue index(VATI-L)group,medium visceral adipose tissue index(VATI-M)group and high visceral adipose tissue index(VATI-H)group.Preoperative hematological indicators,clinicopathological data,postoperative blood glucose,complications and long-term survival of the three groups were recorded respectively.The postoperative blood glucose fluctuation,the risk of complications,and the 1-year and 3-year overall survival(OS)were compared among the three groups.Besides,the effects of VATI on postoperative hyperglycemia(HG),complications and OS were evaluated by binary Logistic regression and COX proportional regression model.Results:1.Compared with the VATI-L group(n=27)and the VATI-M group(n=150),the VATI-H group(n=41)had a higher incidence of HG(40.7%vs 63.3%vs 75.6%,P=0.014)and a higher incidence of overall complications(18.5%vs 13.3%vs 39.0%,P=0.001).In addition,fasting venous plasma glucose(VPG)and capillary blood glucose at 06:00(CBG1)on the postoperative day 1(POD1),and the mean value(BGmean)and maximum value(BGmax)of blood glucose during SPN were higher,while the coefficient of variation of intraday blood glucose(CV)and blood glucose control rate(BGCR)were lower(P<0.05 after Bonferroni correction).2.The postoperative incidence of HG was 62.8%.The binary Logistic regression analysis found that VATI,preoperative hemoglobin and maximum BG before SPN(Pre-SPN BGmax)were independent influencing factors of postoperative HG,with low VATI being the protective factor.The incidence of postoperative complications above grade II was 18.8%.Higher VATI,total gastrectomy and higher BGmean during SPN were independent risk factors for postoperative complications above II grade(P<0.05).3.The Kaplan-Meier survival curves confirmed that the 1-year and 3-year OS were77.0%and 37.2%of VATI-L group、86.2%and 61.9%of VATI-M group、97.6%and75.6%of VATI-H group,respectively.Log-rank significance test showed that the difference in OS between the VATI-L group and VATI-H group were statistically significant(P=0.006),and this difference still existed after adjusting TNM stage between VATI-L group and VATI-H group by using propensity score matching(P=0.044).Subgroup analysis showed that the OS of HG patients before bedtime in VATI-L group was significantly shorter than that in VATI-M group and VATI-H group(P=0.006,P=0.003),but there was no difference in OS among different VATI groups in fasting HG subgroup;The VATI-H group was significantly correlated with longer OS in patients with p TNM stage I～II,but not in patients with stage III;The VATI-L group was associated with shorter OS in patients who were not overweight(BMI<25 kg/m~2)but not in patients who were overweight(BMI≥25 kg/m~2).4.Lower preoperative VATI and lymphocyte/monocytic ratio(LMR),laparotomy,p TNM stage II～III,special pathological type and higher comprehensive complications index(CCI)were independently associated with poor OS(P<0.05).Conclusions:1.Preoperative VATI affects the occurrence of HG during SPN in patients with non-diabetic gastric cancer after surgery,namely that the higher the VATI,the higher the incidence of HG and the worse the glycemic control rate during SPN.2.Higher preoperative VATI,total gastrectomy and higher mean blood glucose value(BGmean)during SPN were independently associated with increased incidence of postoperative complications.However,higher VATI improves the long-term prognosis of non-overweight gastric cancer patients,but has nothing to do with OS of overweight patients.