Impact of Poor Preoperative Glycemic Control on Outcomes among Patients with Cervical Cancer Undergoing a Radical Hysterectomy

Background: The impact of preoperative glycemic control on the survival outcomes of patients undergoing a radical hysterectomy (RH) for cervical cancer has not been investigated. Patients and Methods: We reviewed patients who underwent a type III RH for cervical cancer between January 2004 and June 2011 in our institution. Results: A total of 431 patients were included and 83 (19.3%) were diagnosed with diabetes mellitus (DM). Poorly controlled DM (preoperative hemoglobin A(1c) [HbA(1c)] >= 7.0%) was observed in 49 (59.0%) diabetic patients. Compared to patients without DM and diabetic patients with good glycemic control (preoperative HbA(1c) <7.0%), diabetic patients with poor glycemic control had significantly higher risks of tumor recurrence, cervical cancer-specific death, and overall death. In multivariate analysis, DM with poor glycemic control independently predicted recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). We excluded patients without DM and performed a sensitivity analysis. When HbA(1c) levels were treated as a dichotomous variable, preoperative HbA(1c) >= 7.0% was independently associated with RFS, CSS, and OS. When HbA(1c) level was treated as a continuous variable, it remained an independent predictor of RFS, CSS, and OS. Conclusion: DM with poor glycemic control prior to RH was significantly associated with an increased risk of recurrence and mortality in cervical cancer patients. These results underscore the importance of intensive glycemic control and close follow-up for diabetic patients.