Does Preoperative Low HbA1c Predict Esophageal Cancer Outcomes?

Ann Thorac Cardiovasc Surg. 2020 Aug 20;26(4):184-189. doi: 10.5761/atcs.oa.19-00238. Epub 2019 Oct 30.


Background: Although several reports have shown that diabetes is a poor prognostic factor for esophageal cancer, no reports assessed prognostic impact of hemoglobin A1c (HbA1c) in the patients with esophageal cancer. Therefore, we evaluated the prognostic significance of HbA1c in patients with esophageal cancer.

Methods: A total of 137 patients with esophageal carcinoma surgically treated at our institute between 2009 and 2017 were enrolled in this retrospective study. We divided these patients into quarters according to pretreatment levels of HbA1c. We used 5.5% as a cutoff for classifying patients into low (Q1; n = 30) and high (Q2, Q3, Q4; n = 107) HbA1c groups. Univariate and multivariate analyses were then used to evaluate the clinicopathological and prognostic significance of pretreatment level of HbA1c.

Results: There was no significant relationship between HbA1c level and clinicopathological factors. The low HbA1c group had a significantly worse survival rate as compared to that of the high HbA1c group (overall survival p = 0.04, relapse-free survival p = 0.02). However, the difference was not confirmed in the multivariate analysis.

Conclusion: Although low level of pretreatment HbA1c might be associated with poor prognosis for patients with esophageal cancer, low HbA1c was not an independent risk factor.

Keywords: HbA1c; esophageal cancer; prognosis.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Down-Regulation
  • Esophageal Neoplasms / blood*
  • Esophageal Neoplasms / mortality
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / surgery
  • Esophagectomy
  • Female
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Progression-Free Survival
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors


  • Biomarkers
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human