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Horm Metab Res 2023; 55(05): 333-342
DOI: 10.1055/a-2038-5830
Original Article: Endocrine Care

Metabolic Syndrome and Clinical Outcomes of Patients with Gastric Cancer: A Meta-Analysis

Zhiyang Huang
1   Department of Gastroenterology, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, China
,
Jianwei Zhou
1   Department of Gastroenterology, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, China
,
Long Chen
2   Center for Rehabilitation Medicine and Department of Anesthesiology, Zhejiang Provincial People’s Hospital, Hangzhou, China
,
Yibing Zhang
1   Department of Gastroenterology, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, China
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Abstract

Metabolic syndrome (MetS) is suggested to participate in the pathogenesis and progress of some cancers via inducing low-grade systemic inflammation. However, the influence of MetS on patients with gastric cancer (GC) remains not fully determined. A systematic review and meta-analysis was therefore performed to evaluate the influence of MetS on clinical outcomes of patients with GC. A search of PubMed, Embase, Web of Science, Wanfang, and CNKI retrieved relevant cohort studies from the inception of the databases to October 11, 2022. We pooled the results using a random-effects model that incorporates heterogeneity. In the meta-analysis, 6649 patients with GC were included, and all of them received gastrectomy. A total of 1248 (18.8%) patients had MetS at baseline. Pooled results showed that MetS was associated with higher risks of postoperative complications [risk ratio (RR): 2.41, 95% confidence interval (CI): 1.85 to 3.14, p<0.001; I2=55%], overall mortality (RR: 1.73, 95% CI: 1.85 to 3.14, p<0.001; I2=77%), and recurrence of GC (RR: 2.00, 95% CI: 1.10 to 3.63, p=0.02; I2=39%). Subgroup analyses showed similar results in prospective and retrospective cohort studies and in studies with MetS diagnosed with the Chinese Diabetes Society criteria and the National Cholesterol Education Program Adult Treatment Panel III criteria (p for subgroup difference all>0.05). In patients with GC after gastrectomy, MetS may be a predictor of high incidence of postoperative complications, cancer recurrence, and overall mortality.

Key words

metabolic syndrome - gastric cancer - gastrectomy - clinical outcomes - meta-analysis


Publication History

Received: 17 November 2022

Accepted after revision: 11 February 2023

Article published online:
03 April 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Xia C, Dong X, Li H. et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J (Engl) 2022; 135: 584-590
    CrossrefPubMedGoogle Scholar
  • 2 Siegel RL, Miller KD, Fuchs HE. et al. Cancer statistics, 2022. CA Cancer J Clin 2022; 72: 7-33
    CrossrefPubMedGoogle Scholar
  • 3 Machlowska J, Baj J, Sitarz M. et al. Gastric cancer: epidemiology, risk factors, classification, genomic characteristics and treatment strategies. Int J Mol Sci 2020 Jun 4 21 (11) 4012
    PubMedGoogle Scholar
  • 4 Yusefi AR, Bagheri Lankarani K, Bastani P. et al. Risk factors for gastric cancer: a systematic review. Asian Pac J Cancer Prev 2018; 19: 591-603
    PubMedGoogle Scholar
  • 5 Irino T, Matsuda S, Wada N. et al. Essential updates 2019/2020: perioperative and surgical management of gastric cancer. Ann Gastroenterol Surg 2021; 5: 162-172
    CrossrefPubMedGoogle Scholar
  • 6 Smyth EC, Nilsson M, Grabsch HI. et al. Gastric cancer. Lancet 2020; 396: 635-648
    CrossrefPubMedGoogle Scholar
  • 7 Miller KD, Nogueira L, Devasia T. et al. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin 2022; 72: 409-436
    CrossrefPubMedGoogle Scholar
  • 8 Uzunlulu M, Telci Caklili O, Oguz A. Association between metabolic syndrome and cancer. Ann Nutr Metab 2016; 68: 173-179
    CrossrefPubMedGoogle Scholar
  • 9 Mili N, Paschou SA, Goulis DG. et al. Obesity, metabolic syndrome, and cancer: pathophysiological and therapeutic associations. Endocrine 2021; 74: 478-497
    CrossrefPubMedGoogle Scholar
  • 10 Fahed G, Aoun L, Bou Zerdan M. et al. Metabolic syndrome: updates on pathophysiology and management in 2021. Int J Mol Sci 2022; 23
    PubMedGoogle Scholar
  • 11 Esposito K, Chiodini P, Colao A. et al. Metabolic syndrome and risk of cancer: a systematic review and meta-analysis. Diabetes Care 2012; 35: 2402-2411
    CrossrefPubMedGoogle Scholar
  • 12 Mariani M, Sassano M, Boccia S. Metabolic syndrome and gastric cancer risk: a systematic review and meta-analysis. Eur J Cancer Prev 2021; 30: 239-250
    CrossrefPubMedGoogle Scholar
  • 13 Zhou CF, Li SK, Zhou YB. Relationship between metabolic syndrome and short-term outcomes of patients with gastric cancer. Chin J Dig Surg 2010; 9: 370-373
    PubMedGoogle Scholar
  • 14 Kim EH, Lee H, Chung H. et al. Impact of metabolic syndrome on oncologic outcome after radical gastrectomy for gastric cancer. Clin Res Hepatol Gastroenterol 2014; 38: 372-378
    CrossrefPubMedGoogle Scholar
  • 15 Wei XL, Qiu MZ, Lin HX. et al. Patients with old age or proximal tumors benefit from metabolic syndrome in early stage gastric cancer. PLoS One 2014; 9: e89965
    CrossrefPubMedGoogle Scholar
  • 16 Hu D, Peng F, Lin X. et al. Preoperative metabolic syndrome is predictive of significant gastric cancer mortality after gastrectomy: The Fujian prospective investigation of cancer (FIESTA) study. EBioMedicine 2017; 15: 73-80
    CrossrefPubMedGoogle Scholar
  • 17 Chen X, Zhang W, Sun X. et al. Metabolic syndrome predicts postoperative complications after gastrectomy in gastric cancer patients: Development of an individualized usable nomogram and rating model. Cancer Med 2020; 9: 7116-7124
    CrossrefPubMedGoogle Scholar
  • 18 Xu LB, Zhang HH, Shi MM. et al. Metabolic syndrome-related sarcopenia is associated with worse prognosis in patients with gastric cancer: A prospective study. Eur J Surg Oncol 2020; 46: 2262-2269
    CrossrefPubMedGoogle Scholar
  • 19 Jin Y, Fu X, Duan X. et al. Correlation of metabolic syndrome with clinicopathological characteristics of patients with gastric cancer. Res Clin 2021; 33: 853-856
    PubMedGoogle Scholar
  • 20 Wu H, Jiang HJ, Wang SL. et al. Impact of metabolic syndrome on the short- and long-term outcomes for the elderly patients with gastric cancer after radical gastrectomy. Clin Res Hepatol Gastroenterol 2022; 46: 102041
    CrossrefPubMedGoogle Scholar
  • 21 Page MJ, Moher D, Bossuyt PM. et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021; 372: n160
    CrossrefPubMedGoogle Scholar
  • 22 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
    Google Scholar
  • 23 Higgins J, Thomas J, Chandler J. et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.2. The Cochrane Collaboration. 2021 www.training.cochrane.org/handbook
    PubMedGoogle Scholar
  • 24 Katayama H, Kurokawa Y, Nakamura K. et al. Extended Clavien-Dindo classification of surgical complications: Japan clinical oncology group postoperative complications criteria. Surg Today 2016; 46: 668-685
    CrossrefPubMedGoogle Scholar
  • 25 Wells GA, Shea B, O’Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2010 http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
    PubMed
  • 26 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539-1558
    CrossrefPubMedGoogle Scholar
  • 27 Patsopoulos NA, Evangelou E, Ioannidis JP. Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol 2008; 37: 1148-1157
    CrossrefPubMedGoogle Scholar
  • 28 Egger M, Davey Smith G, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
    CrossrefPubMedGoogle Scholar
  • 29 Hu D, Zhang M, Zhang H. et al. Prediction of metabolic syndrome for the survival of patients with digestive tract cancer: a meta-analysis. Front Oncol 2019; 9: 281
    CrossrefPubMedGoogle Scholar
  • 30 Luo Y, Liu JS, Dai B. et al. The influence of metabolic syndrome on gastric cancer: a meta-analysis. Asian J Surg 2021; 44: 1596-1597
    CrossrefPubMedGoogle Scholar
  • 31 Grandl G, Wolfrum C. Hemostasis, endothelial stress, inflammation, and the metabolic syndrome. Semin Immunopathol 2018; 40: 215-224
    CrossrefPubMedGoogle Scholar
  • 32 Gluvic Z, Zaric B, Resanovic I. et al. Link between metabolic syndrome and insulin resistance. Curr Vasc Pharmacol 2017; 15: 30-39
    CrossrefPubMedGoogle Scholar
  • 33 Piazuelo MB, Riechelmann RP, Wilson KT. et al. Resolution of gastric cancer-promoting inflammation: a novel strategy for anti-cancer therapy. Curr Top Microbiol Immunol 2019; 421: 319-359
    PubMedGoogle Scholar
  • 34 Kwon HJ, Park MI, Park SJ. et al. Insulin resistance is associated with early gastric cancer: a prospective multicenter case control study. Gut Liver 2019; 13: 154-160
    CrossrefPubMedGoogle Scholar
  • 35 Saisana M, Griffin SM, May FEB. Insulin and the insulin receptor collaborate to promote human gastric cancer. Gastric Cancer 2022; 25: 107-123
    CrossrefPubMedGoogle Scholar
  • 36 Abdel-Rahman O. Insulin-like growth factor pathway aberrations and gastric cancer; evaluation of prognostic significance and assessment of therapeutic potentials. Med Oncol 2015; 32: 431
    CrossrefPubMedGoogle Scholar
  • 37 Tsekrekos A, Lovece A, Chrysikos D. et al. Impact of obesity on the outcomes after gastrectomy for gastric cancer: a meta-analysis. Asian J Surg 2022; 45: 15-26
    CrossrefPubMedGoogle Scholar
  • 38 Tian T, Zhang LQ, Ma XH. et al. Diabetes mellitus and incidence and mortality of gastric cancer: a meta-analysis. Exp Clin Endocrinol Diabetes 2012; 120: 217-223
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Cho H, Yoshikawa T, Oba MS. et al. Matched pair analysis to examine the effects of a planned preoperative exercise program in early gastric cancer patients with metabolic syndrome to reduce operative risk: the adjuvant exercise for general elective surgery (AEGES) study group. Ann Surg Oncol 2014; 21: 2044-2050
    CrossrefPubMedGoogle Scholar
  • 40 Yuan M, Han S, Jia Y. et al. Statins are associated with improved survival of patients with gastric cancer: a systematic review and meta-analysis. Int J Clin Pract 2022; 2022: 4938539
    CrossrefPubMedGoogle Scholar