胃癌（GC）患者经历两种特征性治疗方式（胃切除术或内窥镜下切除术），可能导致术后罹患2型糖尿病（T2D）的风险异质性。我们研究了胃癌幸存者在这两种治疗方法下患T2D发展风险的差异。这项回顾性的全国范围人口队列研究纳入了14,646例接受胃切除术（n=12,918）和内窥镜下切除术（n=1,728）的胃癌患者。我们纳入了术后存活≥5年、无糖尿病史并且未接受辅助化疗的患者。采用Cox回归比较了胃切除组和内窥镜下切除组的T2D风险。考虑到发生T2D和死亡的竞争风险，执行了竞争风险回归。在中位随访时间为8.1年的情况下，内窥镜下切除组和胃切除组的T2D发生率分别为每1000人年7.58和6.98。接受胃切除的患者患T2D的风险明显高于接受内窥镜下切除的患者（危险比[HR]，1.37；95%置信区间[CI]，1.18-1.58；P<0.0001）。亚组分析显示，胃切除与女性患者的T2D风险增加相关（HR，1.72；95% CI，1.22-2.43；P=0.030）。在GC幸存者中，接受胃切除的患者患T2D的风险增加了37%，相比之下接受内窥镜下切除的患者。亚组分析显示，女性患者的T2D风险增加了72%。这些结果为根据不同治疗方式制定针对GC幸存者进行筛查和预防T2D的策略提供了启示。版权所有©2023年由美国外科医师学会。由Wolters Kluwer Health, Inc.出版。保留所有权利。

Patients with gastric cancer (GC) experience two characteristic treatment modalities (gastrectomy or endoscopic resection), which may induce heterogeneity in the risk of post-cancer treatment type 2 diabetes (T2D). We investigated differences in the risk of T2D development in GC survivors according to the two treatment methods.This retrospective nationwide population-based cohort study included 14,646 patients with GC who underwent gastrectomy (n=12,918) and endoscopic resection (n=1,728). We enrolled patients who survived for ≥5 years post gastrectomy or endoscopic resection, no history of diabetes, and had not received adjuvant chemotherapy. The T2D risk was evaluated using Cox regression for the gastrectomy group compared to that for the endoscopic resection group. Given the competing risks of incident T2D and death, a competing risk regression was performed.After a median follow-up duration of 8.1 years, the incidence rates of T2D in the endoscopic resection group and gastrectomy group were 7.58 and 6.98 per 1000 person-years, respectively. Patients undergoing gastrectomy showed a significantly higher risk of developing T2D than patients undergoing endoscopic resection (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.18-1.58; P<0.0001). In subgroup analyses, gastrectomy was associated with increased T2D risk in female patients (HR, 1.72; 95% CI, 1.22-2.43; P=0.030 for interaction).Among GC survivors, patients undergoing gastrectomy showed a 37% increased risk of T2D development compared to patients undergoing endoscopic resection. Subgroup analyses showed that T2D risk increased by up to 72% in female patients. These results provide insights for establishing screening and preventive strategies for GC survivors to prevent T2D according to different treatment modalities.Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.