Impact of type 2 diabetes on the outcomes of neoadjuvant therapy followed by surgery for esophageal cancer: a multi-center retrospective study

Background The prognostic relevance of type 2 diabetes in esophageal cancer patients undergoing neoadjuvant therapy followed by surgery remains unclear. This study assessed whether type 2 diabetes influences perioperative outcomes and long-term survival. Methods A total of 1099 patients who received neoadjuvant therapy followed by surgery at three high-volume institution in China from 2013 to 2024 were included. The diagnosis of type 2 diabetes was based on American Diabetes Association criteria. A 1:4 propensity score matching was performed using the R software. Baseline characteristics, perioperative outcomes, overall survival and progression-free survival were compared. Results After 1:4 matching, 114 patients in the diabetic group and 456 patients in the non-diabetic group were compared. No significant differences were found between non-diabetic and diabetic group regarding length of stay (9 days vs 9 days, P = 0.856), re-operation (2.2% vs 0.9%, P = 0.594), re-admission (1.5% vs 1.8%, P > 0.990), total complications (45.0% vs 51.8%, P = 0.231), or specific complications. At a median follow-up of 1086 days, the 2-year overall survival between non-diabetic and diabetic group was 73.9% vs 77.2%, and the 3-year overall survival was 62.4% vs 67.8% [hazard ratio: 0.840, 95% CI: 0.570–1.220, P = 0.356]. After a median follow-up of 927 days, the 2-year progression-free survival of the two groups was 73.2% vs 65.1%, and the 3-year progression-free survival was 65.2% vs 62.4% [hazard ratio: 1.130, 95% CI: 0.780–1.630, P = 0.529]. Conclusions Type 2 diabetes does not adversely affect perioperative outcomes or long-term survival in esophageal cancer patients undergoing neoadjuvant therapy and surgery.