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    • br Conflicts of Interest br

    2018-11-09


    Conflicts of Interest
    Author Contributions
    Acknowledgements
    Introduction Gastric cancer is a malignant neoplasm with high mortality and is a major public health problem in the world (Van Cutsem et al., 2016). In China, gastric cancer is the second most common cancer and the second leading cause of cancer-related death largely due to late diagnosis and aggressive nature of the disease (Chen et al., 2016; Zhang et al., 2016; Fujita, 2009). Even with surgical management, the prognosis of gastric cancer is still unsatisfactory, with an estimated 5-year survival rate of 20–25% in China (Hartgrink et al., 2009). Considerable efforts have been made to determine the risk factors for gastric cancer and to identify biomarkers in order to enhance screening and early detection and to better predict the clinical outcomes (Saragoni et al., 2013; Tiberio et al., 2015; Oyama et al., 2013; Hiraki et al., 2011; Lv et al., 2015). In addition to intensified screening for early detection, it is of timely and clinical importance to find novel approaches to improve the prognosis and prolong the survival of patients with gastric cancer. One of the practical approaches is to determine easily obtainable clinical markers with prognostic significance to guide the optimal intervention and treatment strategies. Metabolic syndrome (MetS) is composed of an array of metabolic diseases, including obesity, hyperglycemia, dyslipidemia, and high blood pressure, and has been known to be a major contributor to the increased cardiovascular disease and type 2 order NHS Biotin risk (Alberti et al., 2009). Recent studies also demonstrate a carcinogenic function of MetS in many types of cancer, including gastric cancer (Cantiello et al., 2015; Zhu et al., 2010; Pasanisi et al., 2006; Wei et al., 2014; Kim et al., 2014). Several large cohort studies from Western countries, including the United States, have investigated the association of MetS and single metabolic risk elements with gastric cancer development and clinical outcomes (Lin et al., 2015; Lindkvist et al., 2013). MetS, especially its component hyperglycemia, was identified as a promising risk factor for gastric cancer in women (Lin et al., 2015; Lindkvist et al., 2013). However, published data on the prognosis of preoperative MetS complication for gastric cancer mortality are very limited. A retrospective study by Wei et al. revealed that preoperative MetS status was a significant and independent predictor for better survival among 587 Chinese patients with early stage gastric cancer (Wei et al., 2014). In contrast, another study among 505 Korean patients receiving radical gastrectomy for gastric cancer demonstrated that the coexistence of MetS before surgery increased the risk of gastric cancer mortality and control of MetS might improve the therapeutic efficacy (Kim et al., 2014). These conflicting and inconclusive results are likely due to the retrospective designs and a small cohort of patients in these studies (Wei et al., 2014; Kim et al., 2014). To better evaluate the potential contribution of preoperative MetS to the mortality of postoperative gastric cancer patients, we elicited a subset of data from the Fujian prospective investigation of cancer (FIESTA) study that incorporated 3012 patients with gastric cancer over a 15-year follow-up period.
    Methods
    Results
    Discussion The MetS is composed of a cluster of metabolic abnormalities, including obesity, hypertension, hyperglycemia, and dyslipidemia, with insulin resistance as the common pathophysiology (Samson and Garber, 2014). Mounting evidence suggests that insulin plays a pivotal role in the regulation of cell proliferation, differentiation, and apoptosis through insulin receptor and insulin-like growth factor 1 receptor, both of which are expressed in gastric cancer cells (Godsland, 2010; Salisbury and Tomblin, 2015; Bardou et al., 2013). The inhibition of these two receptors reduces cancer cell proliferation and accelerates cell death (Mu et al., 2012; Suda et al., 2014). As such, combating insulin resistance has been proposed as a useful preventive and therapeutic strategy for cancer therapy (Djiogue et al., 2013). It is likely that the strong association of preoperative MetS with poor survival of gastric cancer in our study results from the insulin resistance (Fig. 3). Additionally, we also found that the prognostic value of MetS was dominated by elevated fasting blood glucose (hyperglycemia) (Fig. 4). Glucose serves as an energy source for many cells, especially for the highly proliferative cancer cells, and has a direct tumor-promoting effect (Samani et al., 2007). Furthermore, hyperglycemia stimulates the generation of insulin and insulin-like growth factor 1 that in turn trigger tumor growth (Busaidy et al., 2015). Therefore, control of MetS, especially hyperglycemia, could improve the prognosis and prolong the survival of patients with gastric cancer.