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

Impact of type 2 diabetes on the outcomes of neoadjuvant therapy followed by surgery for esophageal cancer: a multi-center retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of type 2 diabetes on the outcomes of neoadjuvant therapy followed by surgery for esophageal cancer: a multi-center retrospective study Xipeng Wang, Zhichao Liu, Xuefeng Leng, Xinmin Li, Jingwen Zhang, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8458597/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract 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. Esophageal Neoplasms Esophagectomy Neoadjuvant Therapy Type 2 Diabetes Mellitus Figures Figure 1 Figure 2 Figure 3 Background Esophageal cancer ranks as the 11th most common cancer and the 7th leading cause of cancer-related mortality worldwide, accounting for approximately 510,716 new cases and 445,129 deaths in 2022 1 . In Asian countries, over 90% of esophageal cancer cases are esophageal squamous cell carcinomas (ESCC) 2 . Over the past two decades, neoadjuvant therapy (NAT) has significantly transformed the treatment landscape for locally advanced esophageal cancer 3 , 4 . According to the findings of the CROSS and NEOCRTEC5010 trials, preoperative chemoradiotherapy plus surgery is recommended as a standard treatment for locally advanced esophageal cancer 5 , 6 . Meanwhile, according to the 2021 report by the International Diabetes Federation (IDF), approximately 537 million individuals globally were affected with diabetes, constituting roughly 10.5% of the world's populace 7 . In the last two decades, the significant rise in type 2 diabetes mellitus (T2DM) prevalence across most countries has indicated a potential link between diabetes and cancer 8 . T2DM patients have shown an increased incidence of several cancers, including gastric cancer 9 , liver cancer 10 , pancreatic cancer 11 , colorectal cancer 12 and renal cancer 13 . In contrast, a lower incidence of prostate cancer has been observed in diabetic patients, suggesting a potential protective effect of diabetes 14 . While epidemiological studies have suggested an association between T2DM and an elevated risk of multiple malignancies, its potential impact on treatment-related outcomes and survival in several types of cancer, including lung cancer 15 , 16 and esophageal cancer 17 , 18 has not been well established. T2DM is one of the most common chronic metabolic diseases among patients with EC 19,20 . To date, whether T2DM can impact the efficacy and long-term survival of NAT followed by surgery for esophageal cancer remains unknown. Therefore, we aim to investigate whether patients with T2DM have similar clinical outcomes compared to those without T2DM. We hypothesized that T2DM does not worsen perioperative outcomes or survival in esophageal cancer patients undergoing NAT followed by surgery. Methods Study design We conducted a three-centre, retrospective cohort study of consecutive patients with esophageal cancer who underwent NAT followed by surgery at Shanghai Ruijin Hospital, Shanghai Chest Hospital and Sichuan Cancer Hospital between January 2013 and September 2024 (Fig. 1 ), which has been approved by the Ethics Committee of the three Hospitals (IRB number: KY-202425, October 15, 2024). Written informed consent was waived. Patients were excluded if they (1) had previous malignant diseases; (2) had a history of previous gastric or gastroesophageal junction cancer surgery; (3) declined neoadjuvant therapy; (4) declined surgery. Diagnosis of T2DM A diagnosis of type 2 diabetes mellitus is based on a patient’s documented history of T2DM and/or the use of antidiabetic medications in the hospital medical record. All the diagnosis should adhere to the criteria outlined in the American Diabetes Association (ADA) “Standards of Care in Diabetes—2024” 21 . These criteria include: a glycosylated hemoglobin (HbA1c) level exceeding 6.5% (≥ 48 mmol/mol), a fasting plasma glucose concentration (FPG) above 7.0 mmol/L, a random plasma glucose concentration surpassing 11.1 mmol/L, or a 2-hour plasma glucose (2-h PG) concentration greater than 11.1 mmol/L during an oral glucose tolerance test (OGTT) 22 . Blood sugar levels were rigorously controlled by insulin injections during the perioperative period with close collaboration between oncologists, surgeons, and endocrinologists. Neoadjuvant therapy and surgical techniques NAT included chemotherapy, radiotherapy, and immunotherapy, with the most common regimens being neoadjuvant chemoradiotherapy (nCRT) or nCRT combined with immunotherapy (nCRT + I). Chemoradiotherapy was administered according to the CROSS protocol 5 . After 4–6 weeks, patients were reassessed for contraindications and subsequently received surgery if appropriate. Esophagectomy was performed using either open or minimally invasive approaches, including McKeown or Ivor-Lewis procedures, via video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracic surgery (RATS). Two-field or three-field lymphadenectomy was performed according to tumor location and intraoperative findings. Outcome measures Baseline characteristics and surgical information were collected. Primary endpoints were perioperative outcomes and long-term survival. The Clavien Dindo Classification is used to rank the severity of a surgical complication. OS was measured from the date of diagnosis of esophageal cancer until death or last follow-up. Progression-free survival (PFS) was defined as the time from the date of diagnosis of esophageal cancer until the first observation of disease progression (e.g., recurrence or metastasis) or death, whichever occurred first. Propensity score matching To reduce the impact of potential confounders on selection bias, a 1:4 propensity score matching (PSM) was performed between the two groups using the nearest-neighbor method with a caliper of 0.05. The most likely factors affecting the analysis results were selected, including sex, age, body mass index (BMI), other comorbidities, smoking history, alcohol consumption, neoadjuvant modality, surgical technique, histology, tumor location, tumor regression grade, pT category, pN category and pM category. Statistical Analysis All statistical analyses were conducted using R software (version 4.3.3; R Foundation for Statistical Computing, Vienna, Austria). The differences in baseline characteristics and perioperative outcomes between the two groups were evaluated using the χ² test or Fisher’s exact test for categorical variables, t-test for continuous variables with normal distribution, and non-parametric tests for continuous variables without normal distribution, as appropriate. Survival rates were estimated using Kaplan-Meier curves and compared with log-rank tests. PSM analysis was also performed using R software. A two-sided P value < 0.05 was considered statistically significant. Results Patient characteristics A total of 1,099 patients who underwent NAT followed by surgery were included. Patients were divided into a diabetic group (n = 114) and a non-diabetic group (n = 985). After 1:4 propensity score matching (PSM), 114 diabetic patients were matched with 456 non-diabetic patients. In the matched cohort, the non-diabetic group comprised 376 males (82.5%) and 80 females (17.5%), while the diabetic group included 92 males (80.7%) and 22 females (19.3%). Median age was 65 years (interquartile range, 59 to 70) in the non-diabetic group and 64.5 years (interquartile range, 60 to 69) in the diabetic group. Baseline characteristics are summarized in Table 1 . Before matching, patients in the diabetic group had a higher body mass index (BMI) and a greater prevalence of other comorbidities compared with the non-diabetic group (P < 0.05); these differences were balanced after PSM. No other significant differences were observed before or after matching. All subsequent analyses were performed on the matched cohort. Table 1 Patient characteristics Before PSM After PSM Characteristic Non-diabetic (n = 985) Diabetic (n = 114) P value Non-diabetic (n = 456) Diabetic (n = 114) P value Sex (n) 0.398 0.764 Male 830(84.3%) 92(80.7%) 376 (82.5%) 92 (80.7%) Female 155(15.7%) 22(19.3%) 80 (17.5%) 22 (19.3%) Age at diagnosis (yr), median (IQR) 64.00 [57.00, 68.00] 64.50 [60.00,69.00] 0.05 65.00 [59.00,70.00] 64.50 [60.00,69.00] 0.92 BMI (kg/m2), median (IQR) 22.32 [20.57, 24.46] 22.99 [21.27,24.95] 0.041 23.03 [21.06,25.05] 22.99 [21.27,24.95] 0.931 Smoking history (n) 591(60.0%) 60(52.6%) 0.157 251 (55.0%) 60 (52.6%) 0.721 Drinking history (n) 559(56.8%) 62(54.4%) 0.702 252 (55.3%) 62 (54.4%) 0.950 Other comorbidities (n) 245(24.9%) 61(53.5%) < 0.001 211 (46.3%) 61 (53.5%) 0.201 Tumor location (n) 0.246 0.977 Cervical esophagus 10(1.0%) 2(1.8%) 7 (1.5%) 2 (1.8%) Upper esophagus 100(10.1%) 18(15.8%) 60(13.2%) 18(15.8%) Middle esophagus 468(47.6%) 54(47.4%) 230(50.4%) 54(47.4%) Lower esophagus 365(37.1%) 38(33.3%) 153(33.6%) 38(33.3%) Upper + Middle + Lower esophagus 1(0.1%) 0(0%) 0(0%) 0(0%) Esophago-gastric junction 41(4.1%) 2(1.8%) 6(1.3%) 2(1.8%) Histology (n) 0.281 0.561 ESCC 903(91.7%) 100(87.7%) 413 (90.6%) 100 (87.7%) EAC 28(2.8%) 6(5.3%) 15 (3.3%) 6 (5.3%) Other 54(5.5%) 8(7.0%) 28 (6.1%) 8 (7.0%) Neoadjuvant modality (n) 0.363 0.981 CRT 475(48.2%) 50(43.9%) 203 (44.5%) 50 (43.9%) CRT + I 76(7.7%) 14(12.3%) 49 (10.7%) 14 (12.3%) CT 60(6.1%) 4(3.5%) 13 (2.9%) 4 (3.5%) CT + I 366(37.2%) 45(39.5%) 186 (40.8%) 45 (39.5%) RT 8(0.8%) 1(0.9%) 5 (1.1%) 1 (0.9%) Tumor regression grade (n) 0.329 0.961 0 351(35.6%) 34(29.8%) 140 (30.7%) 34 (29.8%) 1 226(22.9%) 31(27.2%) 119 (26.1%) 31 (27.2%) 2 154(15.6%) 23(20.2%) 85 (18.6%) 23 (20.2%) 3 254(25.8%) 26(22.8%) 112 (24.6%) 26 (22.8%) ypTNM (n) 0.211 0.919 0 73(7.4%) 13(11.4%) 42 (9.2%) 13 (11.4%) I 357(36.2%) 37(32.5%) 161 (35.3%) 37 (32.5%) II 196(19.9%) 30(26.3%) 110 (24.1%) 30 (26.3%) III 281(28.5%) 26(22.8%) 111 (24.3%) 26 (22.8%) IV 78(7.9%) 8(7.0%) 32 (7.0%) 8 (7.0%) Surgical information Surgical information are presented in Table 2 . No statistically significant differences were observed between non-diabetic and diabetic group both before and after PSM in terms of ASA score, surgical technique, surgical margin, anastomosis location, esophageal replacement organ, number of lymph node dissection, intravascular infiltration, nerve invasion and lymphatic metastasis. Prior to PSM, a switching of surgical method was required in 16 patients (1.6%) within the non-diabetic group and in 3 patient (0.3%) in the diabetic group, primarily due to severe adhesions and anatomical variations, with no statistically significant difference (P = 0.833). Intraoperative complications, including massive hemorrhage, cardiac arrest, and splenectomy, were reported in 3 patients (0.3%) in the non-diabetic group, while no such complications were observed in the diabetic group, with no statistically significant difference noted (P > 0.99). After PSM, the results also indicate no statistically significant difference between non-diabetic and diabetic group. Table 2 Surgical information Before PSM After PSM Characteristic Non-diabetic (n = 985) Diabetic (n = 114) P value Non-diabetic (n = 456) Diabetic (n = 114) P value ASA score (n) 0.066 0.131 Ⅰ 23 (2.3%) 1 (0.9%) 11 (2.4%) 1 (0.9%) Ⅱ 654 (66.4%) 73 (64.0%) 299 (65.6%) 73 (64.0%) Ⅲ 291 (29.5%) 34 (29.8%) 138 (30.3%) 34 (29.8%) Ⅳ 17 (1.75) 6 (5.3%) 8 (1.8%) 6 (5.3%) Surgical technique (n) 0.745 0.923 Open 127 (12.9%) 16 (14.0%) 61 (13.4%) 16 (14.0%) Video-assisted 547 (55.5%) 59 (51.8%) 230 (50.4%) 59 (51.8%) Robot-assisted 311 (31.6%) 39 (34.2%) 165 (36.2%) 39 (34.2%) Surgical margin (n) 0.252 0.384 R0 959 (97.4%) 108 (94.7%) 442 (96.9%) 108 (94.7) R1 15 (1.5%) 4 (3.5%) 7 (1.5%) 4 (3.5%) R2 11 (1.1%) 2 (1.8%) 7 (1.5%) 2 (1.8%) Anastomosis location (n) 0.53 0.776 Neck 849 (86.2%) 94 (82.5%) 388 (85.1%) 94 (82.5%) Chest 131 (13.3%) 19 (16.7%) 64 (14.0%) 19 (16.7%) Abdomen 5 (0.5%) 1 (0.9%) 4 (0.9%) 1 (0.9%) Esophageal replacement organ (n) 0.368 0.469 Tubular stomach 968 (98.3) 114 (100.0) 450 (98.7%) 114 (100.0%) Other 17(1.7%) 0(0.0%) 6 (1.3%) 0 (0.0%) Number of lymph node dissection (n), median (IQR) 21.00 [14.00, 29.00] 20.00 [14.00,30.00] 0.989 21.00 [14.00,29.00] 20.00 [14.00,30.00] 0.982 Intravascular infiltration (n) 0.464 0.486 Yes 142 (14.4%) 13 (11.4%) 66 (14.5%) 13 (11.4%) No 843 (85.6%) 101 (88.6%) 390 (85.5%) 101 (88.6%) Nerve invasion (n) 0.836 0.857 Yes 132 (13.4%) 13 (11.4%) 60 (13.2%) 13 (11.4%) No 853 (86.6%) 101 (88.6%) 396 (86.8%) 101 (88.6%) Lymphatic metastasis (n) 0.334 0.912 Yes 370 (37.6%) 37 (32.5%) 153 (33.6%) 37 (32.5%) No 615 (62.4%) 77 (67.5%) 303 (66.4%) 77 (67.5%) Switching of surgical method (n) 16 (1.6%) 1 (0.9%) 0.833 9 (2.0%) 1 (0.9%) 0.69 Intraoperative complication (n) 3(0.3%) 0(0.0%) > 0.99 2 (0.4%) 0 (0.0%) > 0.99 Postoperative outcomes Perioperative outcomes are summarized in Table 3 . No statistically significant differences were observed between the two groups both before and after PSM in terms of length of stay (LOS), re-operation or re-admission within 30 days, total complications, specific complications (including anastomotic leakage, pleural effusion, pneumonia) and other complications. Table 3 Perioperative outcomes Before PSM After PSM Characteristic Non-diabetic (n = 985) Diabetic (n = 114) P value Non-diabetic (n = 456) Diabetic (n = 114) P value LOS after surgery (d), median (IQR) 9.00 [8.00, 12.00] 9.00 [8.00, 12.00] 0.983 9.00 [7.00, 12.00] 9.00 [8.00, 12.00] 0.856 Re-operation within 30 days (n) 16 (1.6%) 1 (0.9%) 0.833 10 (2.2%) 1 (0.9%) 0.594 Re-admission within 30 days (n) 21 (2.1%) 2 (1.8%) > 0.99 7 (1.5%) 2 (1.8%) > 0.99 Total complications (n) 445 (45.2%) 59 (51.8%) 0.217 205 (45.0%) 59 (51.8%) 0.231 Anastomotic leakage (n) 85 (8.6%) 7 (6.1%) 0.465 40 (8.8%) 7 (6.1%) 0.469 Ⅰ 6 (0.6%) 0 (0.0%) 4 (0.9%) 0 (0.0%) Ⅱ 45 (4.6%) 5 (4.4%) 18 (3.9%) 5 (4.4%) Ⅲ 28(2.8%) 2(1.8%) 14 (3.1%) 2 (1.8%) Ⅳ 6(0.6%) 0(0.0%) 4 (0.9%) 0 (0.0%) Pleural effusion (n) 113 (11.5%) 14 (12.3%) 0.92 64 (14.0%) 14 (12.3%) 0.738 Ⅰ 39 (4.0%) 4 (3.5%) 16 (3.5%) 4 (3.5%) Ⅱ 18 (1.8%) 1 (0.9%) 12 (2.6%) 1 (0.9%) Ⅲ 56 (5.7%) 9 (7.9%) 36 (7.9%) 9 (7.9%) Pneumonia (n) 177 (18.0%) 23 (20.2%) 0.653 88 (19.3%) 23 (20.2%) 0.937 Ⅰ 13 (1.3%) 2 (1.8%) 5 (1.1%) 0 (0.0%) Ⅱ 134 (13.6%) 19 (16.7%) 70 (15.4%) 21 (18.4%) Ⅲ 17(1.7%) 2(1.8%) 6(1.3%) 2(1.8%) Ⅳ 9(0.9%) 0(0.0%) 4 (0.9%) 0 (0.0%) Ⅴ 4(0.4%) 0(0.0%) 3 (0.7%) 0 (0.0%) Other complications (n) 234 (23.8%) 31 (27.2%) 0.486 98 (21.5%) 31 (27.2%) 0.24 After PSM, there was no significant difference in LOS after surgery between non-diabetic and diabetic group [9 days (IQR 7–12 days) vs. 9 days (IQR 8–12days), P = 0.856]. Rates of 30-day reoperation (P = 0.594) and readmission (P > 0.99) were similar. Overall complication rates were comparable (45.0% vs 51.8%, P = 0.231). No significant differences were found in anastomotic leakage (P = 0.469), pleural effusion (P = 0.738), pneumonia (P = 0.937), or other complications, including cardiac events, chylothorax, vocal cord paralysis, and wound infection (P = 0.24). Survival outcomes After PSM, median follow-up was 1,086 days (95% CI 1,079–1,090). The 2-year overall survival (OS) rate was 73.9% (95% CI 69.7–78.4%) in the non-diabetic group and 77.2% (95% CI 69.4–85.9%) in the diabetic group; 3-year OS rates were 62.4% (95% CI 57.4–67.7%) and 67.8% (95% CI 58.7–78.3%), respectively. The hazard ratio (HR) for OS was 0.84 (95% CI 0.57–1.22; P = 0.356), indicating no significant difference between groups (Fig. 2 ). Median follow-up for progression-free survival (PFS) was 927 days (95% CI 907–1,078). The 2-year PFS rate was 73.2% (95% CI 68.8–77.9%) in non-diabetic patients versus 65.1% (95% CI 56.1–75.7%) in diabetic patients; 3-year PFS rates were 65.2% (95% CI 60.1–70.8%) and 62.4% (95% CI 53.1–73.3%), respectively. The HR for PFS was 1.13 (95% CI 0.78–1.63; P = 0.529), with no statistically significant difference (Fig. 3 ). Discussion This study evaluated the impact of type 2 diabetes mellitus (T2DM) on perioperative outcomes and long-term survival in esophageal cancer patients undergoing NAT followed by surgery, using propensity score matching (PSM) to minimize confounding. The similar incidence of perioperative complications between the two groups reinforces the notion that diabetes may not substantially increase immediate surgical risks. This finding aligns with prior studies emphasizing the importance of perioperative glycemic control and a multidisciplinary approach in minimizing complications for diabetic patients undergoing major surgeries 23 , 24 . The ADA recommends maintaining perioperative blood glucose between 80–180 mg/dL, with tighter control in critically ill patients 25 . Optimal management involves preoperative identification of poorly controlled diabetes, intraoperative glucose monitoring, and postoperative strategies to avoid both hyper- and hypoglycemia. Collaboration among endocrinologists, anesthesiologists, and surgeons appears to improve outcomes in diabetic patients undergoing complex procedures. Long-term outcomes, including OS and PFS, were also similar between groups, indicating that T2DM may not independently compromise survival. These findings contrast with some studies reporting worse outcomes in diabetic cancer patients 26 , 27 . Several factors may explain the inconsistency in the conclusions across studies. Patient characteristics, for example, can vary significantly. Some studies have included individuals with a longer duration of diabetes or pre-existing cardiovascular disease, which may have contributed to higher mortality and poorer postoperative outcomes. Additionally, the heterogeneity within diabetic populations—ranging from well-controlled early-stage diabetes to poorly controlled, long-standing diabetes, adds complexity to understanding the true impact of diabetes on cancer outcomes. Studies focusing on well-controlled diabetic patients are likely to report more favorable results compared to those involving a more diverse group with varying levels of disease control. Treatment protocols also play a crucial role. Diabetic patients may exhibit lower adherence to recommended cancer therapies, such as chemotherapy and radiotherapy, possibly due to comorbidities or concerns regarding treatment-related side effects. Our findings suggest that with appropriate management, diabetic patients can achieve outcomes similar to their non-diabetic counterparts. Meanwhile, several limitations must be acknowledged. First, although PSM was employed, residual confounding from unmeasured factors may still persist. Second, information on duration of diabetes, HbA1c trajectory and medication use was not uniformly available, which may limit our ability to stratify patients by diabetes severity. Finally, the retrospective design has inherent biases. Future multi-center, prospective studies are needed to validate these findings. Conclusions In conclusion, T2DM does not appear to compromise perioperative safety or long-term survival in esophageal cancer patients undergoing NAT followed by surgery. These findings provide reassurance that with appropriate multidisciplinary management, diabetic patients can achieve comparable outcomes to their non-diabetic counterparts. Abbreviations 2-h PG 2-hour Plasma Glucose ADA American Diabetes Association ASA American Society of Anesthesiologists BMI Body Mass Index CI Confidence Interval EC Esophageal Cancer ESCC Esophageal Squamous Cell Carcinoma FPG Fasting Plasma Glucose HbA1c Hemoglobin A1c HR Hazard Ratio IDF International Diabetes Federation IQR Interquartile Range IRB Institutional Review Board LOS Length of Stay NAT Neoadjuvant Therapy nCRT Neoadjuvant Chemoradiotherapy nCRT+I Neoadjuvant Chemoradiotherapy combined with Immunotherapy OGTT Oral Glucose Tolerance Test OS Overall Survival PFS Progression-Free Survival PSM Propensity Score Matching RATS Rrobotic-assisted thoracic surgery VATS Video-assisted thoracoscopic surgery T2DM Type 2 Diabetes Mellitus Declarations Ethics approval and consent to participate: This study was approved by the Ethics Committee of the three Hospitals (IRB number: KY-202425, October 15, 2024). Written informed consent was waived. Consent for publication: All authors have consented to the publication of this manuscript and guarantee that the data and results presented are accurate and reliable. Funding: This study was supported by the National Natural Science Foundation of China (82372855, 82072557 and 82472663), National Key Research and Development Program of China (2021YFC2500900), Shanghai Municipal Education Commission - Gaofeng Clinical Medicine Grant (20172005, the 2nd round of disbursement), program of Shanghai Academic Research Leader from Science and Technology Commission of Shanghai Municipality (20XD1402300), Novel Interdisciplinary Research Project from Shanghai Municipal Health Commission (2022JC023), Interdisciplinary Program of Shanghai Jiao Tong University (YG2023ZD04), Clinical Research Project in Health Services of Shanghai Municipal Health Commission (202240089) and National Translational Medicine Center (Shanghai) Open Project (NRCTM(SH)-2025-12). Author Contribution Conceptualization: Hecheng Li, Yuqin Cao, Yongtao Han, Zhigang LiData Curation: Xipeng Wang, Xuefeng Leng, Zhichao Liu, Jingwen Zhang, Xiaoting YuFormal analysis: Xipeng Wang, Yuqin Cao, Zhichao LiuFunding acquisition: Hecheng Li, Yongtao Han, Zhigang LiInvestigation: Xipeng Wang, Xuefeng Leng, Zhichao Liu, Xinmin Li, Jingwen Zhang, Xiaoting YuMethodology: Xipeng Wang, Yuqin Cao, Zhichao LiuProject administration: Hecheng Li, Yuqin Cao, Yongtao Han, Zhigang LiResources: Xinmin Li, Jingwen Zhang, Xiaoting Yu, Chengqiang Li, Wei GuoSoftware: Xipeng Wang, Xinmin Li, Jingwen Zhang, Xiaoting Yu, Yuqin CaoSupervision: Hecheng Li, Yuqin Cao, Yongtao Han, Zhigang LiValidation: Xuefeng Leng, Zhichao Liu, Wei Guo, Chengqiang LiVisualization: Xipeng Wang, Xinmin Li, Jingwen Zhang, Xiaoting YuWriting – original draft: Xipeng Wang, Xuefeng Leng, Zhichao LiuWriting – review & editing: Hecheng Li, Yuqin Cao, Yongtao Han, Zhigang Li, Chengqiang Li, Wei Guo Acknowledgements: None. 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Diabetologia. 2017/06/01 2017;60(6):1022–32. 10.1007/s00125-017-4229-z Bansal D, Bhansali A, Kapil G, Undela K, Tiwari P. Type 2 diabetes and risk of prostate cancer: a meta-analysis of observational studies. Prostate Cancer Prostatic Dis. 2013/06/01 2013;16(2):151–8. 10.1038/pcan.2012.40 Varlotto J, Medford-Davis LN, Recht A, et al. Confirmation of the role of diabetes in the local recurrence of surgically resected non-small cell lung cancer. Lung Cancer Mar. 2012;75(3):381–90. 10.1016/j.lungcan.2011.07.019 . Hatlen P, Grønberg BH, Langhammer A, Carlsen SM, Amundsen T. Prolonged survival in patients with lung cancer with diabetes mellitus. J Thorac Oncol Nov. 2011;6(11):1810–7. 10.1097/JTO.0b013e31822a75be . Yao W, Meng Y, Lu M et al. Impact of type 2 diabetes mellitus on short-term and long-term outcomes of patients with esophageal squamous cell cancer undergoing resection: a propensity score analysis. Cancer Commun (Lond). Apr 27. 2018;38(1):14. 10.1186/s40880-018-0275-2 Zheng X, Ma X, Deng H-Y, et al. Diabetes mellitus and survival of esophageal cancer patients after esophagectomy: a systematic review and meta-analysis. Dis Esophagus. 2020;33(2). 10.1093/dote/doz098 . Zhou B, Wang Z, Dou Q, et al. Long-term outcomes of esophageal and gastric cancer patients with cardiovascular and metabolic diseases: A two-center propensity score-matched cohort study. J Transl Int Med Sep. 2023;11(3):234–45. 10.2478/jtim-2023-0112 . Liu D, Ma Z, Yang J, et al. Prevalence and prognosis significance of cardiovascular disease in cancer patients: a population-based study. Aging (Albany NY) Sep. 2019;27(18):7948–60. 10.18632/aging.102301 . American Diabetes Association Professional Practice C. Introduction and Methodology: Standards of Care in Diabetes-2024. Diabetes Care. Jan 1 2024;47(Supplement_1):S1-S4. 10.2337/dc24-SINT ElSayed NA, Aleppo G, Bannuru RR, et al. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Supplement1):S20–42. 10.2337/dc24-S002 . Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg Mar 1. 2017;152(3):292–8. 10.1001/jamasurg.2016.4952 . Duggan E, Chen Y. Glycemic Management in the Operating Room: Screening, Monitoring, Oral Hypoglycemics, and Insulin Therapy. Curr Diab Rep Nov. 2019;20(11):134. 10.1007/s11892-019-1277-4 . Association AD. 14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018. Diabetes Care. 2017;41(Supplement1):S144–51. 10.2337/dc18-S014 . Lega IC, Austin PC, Fischer HD, et al. The Impact of Diabetes on Breast Cancer Treatments and Outcomes: A Population-Based Study. Diabetes Care Apr. 2018;41(4):755–61. 10.2337/dc17-2012 . Gysling S, Lewis-Lloyd CA, Lobo DN, Crooks CJ, Humes DJ. The effect of diabetes mellitus on perioperative outcomes after colorectal resection: a national cohort study. Br J Anaesth Jul. 2024;133(1):67–76. 10.1016/j.bja.2024.04.010 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 20 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers invited by journal 11 Feb, 2026 Editor invited by journal 29 Dec, 2025 Editor assigned by journal 29 Dec, 2025 Submission checks completed at journal 29 Dec, 2025 First submitted to journal 26 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8458597","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":590650803,"identity":"63c84938-5d03-4553-836b-53694b06ecb4","order_by":0,"name":"Xipeng Wang","email":"","orcid":"","institution":"Ruijin Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xipeng","middleName":"","lastName":"Wang","suffix":""},{"id":590650804,"identity":"a2fafef9-71ee-43c1-8971-37c96b4f6991","order_by":1,"name":"Zhichao Liu","email":"","orcid":"","institution":"Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhichao","middleName":"","lastName":"Liu","suffix":""},{"id":590650805,"identity":"a6b91079-a3e7-4dc5-9b40-d17dd1947b9d","order_by":2,"name":"Xuefeng Leng","email":"","orcid":"","institution":"Sichuan Cancer Hospital \u0026 Institute, Sichuan Cancer Center, Sichuan Clinical Research Center for Cancer, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC)","correspondingAuthor":false,"prefix":"","firstName":"Xuefeng","middleName":"","lastName":"Leng","suffix":""},{"id":590650806,"identity":"90402228-b804-423d-8007-9d2d991d791f","order_by":3,"name":"Xinmin Li","email":"","orcid":"","institution":"Ruijin Hospital, Shanghai Jiao Tong University School of 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Li","email":"","orcid":"","institution":"Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhigang","middleName":"","lastName":"Li","suffix":""},{"id":590650832,"identity":"707e13b9-7560-4ead-abcf-f4ca899c4532","order_by":10,"name":"Hecheng Li","email":"","orcid":"","institution":"Ruijin Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Hecheng","middleName":"","lastName":"Li","suffix":""},{"id":590650837,"identity":"50124b0f-c1f3-4699-8b06-f44de5795866","order_by":11,"name":"Yuqin Cao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYPACCQZ5ZobEBwkVNSRoMWxneGzw4MwxUiw6z/hM8mELM2GF/O2Hj0nzlFnkMTYzp1UkNrABRboT8LvoTFqaNM85iWJ2Zra0G4k7ZIAiZzfg1WLAkGMmzdsmkdjYzAPUcoaNwUAil4AW/jcQLQ2H+b8VJLYxE6FFIgemhSGNgSgtEjeeJVvOOSeRuLGZIVki4cwxHoJ+4e9PPnjjTVld4nz+A4kff1TUyPG39+LXAgQsEgxsCB4PIeUgwPwBWcsoGAWjYBSMAgwAABh0RRjvhyKwAAAAAElFTkSuQmCC","orcid":"","institution":"Ruijin Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Yuqin","middleName":"","lastName":"Cao","suffix":""}],"badges":[],"createdAt":"2025-12-27 04:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8458597/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8458597/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102854416,"identity":"5b9a8d91-00f3-4b0f-9c15-9b0fff801e2c","added_by":"auto","created_at":"2026-02-17 14:49:29","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":111043,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the study\u003c/p\u003e","description":"","filename":"Figure1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8458597/v1/8706155a45de1650cb8dd224.jpeg"},{"id":102963242,"identity":"d6cb00b2-e2bd-44ef-b2c2-71cf2c341583","added_by":"auto","created_at":"2026-02-19 04:14:42","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":154949,"visible":true,"origin":"","legend":"\u003cp\u003eOverall survival between the Non-Diabetic and Diabetic group\u003c/p\u003e","description":"","filename":"Figure2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8458597/v1/fef0d4ac83ea658fd2afbab0.jpeg"},{"id":102854417,"identity":"fe0775d1-d697-47ac-b07c-a7e8dadc5064","added_by":"auto","created_at":"2026-02-17 14:49:29","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":157138,"visible":true,"origin":"","legend":"\u003cp\u003eProgression-free survival between the Non-Diabetic and Diabetic group\u003c/p\u003e","description":"","filename":"Figure3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8458597/v1/0bf5407e3a509426f51e7e76.jpeg"},{"id":102965129,"identity":"c03ab940-ce35-4734-accc-b8c789508d46","added_by":"auto","created_at":"2026-02-19 04:30:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1318542,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8458597/v1/1341ca20-870d-4467-a0e9-fd3d71c5b90f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of type 2 diabetes on the outcomes of neoadjuvant therapy followed by surgery for esophageal cancer: a multi-center retrospective study","fulltext":[{"header":"Background","content":"\u003cp\u003eEsophageal cancer ranks as the 11th most common cancer and the 7th leading cause of cancer-related mortality worldwide, accounting for approximately 510,716 new cases and 445,129 deaths in 2022\u003csup\u003e1\u003c/sup\u003e. In Asian countries, over 90% of esophageal cancer cases are esophageal squamous cell carcinomas (ESCC)\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Over the past two decades, neoadjuvant therapy (NAT) has significantly transformed the treatment landscape for locally advanced esophageal cancer\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. According to the findings of the CROSS and NEOCRTEC5010 trials, preoperative chemoradiotherapy plus surgery is recommended as a standard treatment for locally advanced esophageal cancer\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMeanwhile, according to the 2021 report by the International Diabetes Federation (IDF), approximately 537\u0026nbsp;million individuals globally were affected with diabetes, constituting roughly 10.5% of the world's populace\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. In the last two decades, the significant rise in type 2 diabetes mellitus (T2DM) prevalence across most countries has indicated a potential link between diabetes and cancer\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. T2DM patients have shown an increased incidence of several cancers, including gastric cancer\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, liver cancer\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, pancreatic cancer\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, colorectal cancer\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e and renal cancer\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. In contrast, a lower incidence of prostate cancer has been observed in diabetic patients, suggesting a potential protective effect of diabetes\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. While epidemiological studies have suggested an association between T2DM and an elevated risk of multiple malignancies, its potential impact on treatment-related outcomes and survival in several types of cancer, including lung cancer\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e and esophageal cancer\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e has not been well established.\u003c/p\u003e \u003cp\u003eT2DM is one of the most common chronic metabolic diseases among patients with EC\u003csup\u003e19,20\u003c/sup\u003e. To date, whether T2DM can impact the efficacy and long-term survival of NAT followed by surgery for esophageal cancer remains unknown. Therefore, we aim to investigate whether patients with T2DM have similar clinical outcomes compared to those without T2DM. We hypothesized that T2DM does not worsen perioperative outcomes or survival in esophageal cancer patients undergoing NAT followed by surgery.\u003c/p\u003e "},{"header":"Methods","content":" \u003cp\u003eStudy design\u003c/p\u003e \u003cp\u003e We conducted a three-centre, retrospective cohort study of consecutive patients with esophageal cancer who underwent NAT followed by surgery at Shanghai Ruijin Hospital, Shanghai Chest Hospital and Sichuan Cancer Hospital between January 2013 and September 2024 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), which has been approved by the Ethics Committee of the three Hospitals (IRB number: KY-202425, October 15, 2024). Written informed consent was waived. Patients were excluded if they (1) had previous malignant diseases; (2) had a history of previous gastric or gastroesophageal junction cancer surgery; (3) declined neoadjuvant therapy; (4) declined surgery.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDiagnosis of T2DM\u003c/p\u003e \u003cp\u003eA diagnosis of type 2 diabetes mellitus is based on a patient\u0026rsquo;s documented history of T2DM and/or the use of antidiabetic medications in the hospital medical record. All the diagnosis should adhere to the criteria outlined in the American Diabetes Association (ADA) \u0026ldquo;Standards of Care in Diabetes\u0026mdash;2024\u0026rdquo;\u003csup\u003e21\u003c/sup\u003e. These criteria include: a glycosylated hemoglobin (HbA1c) level exceeding 6.5% (\u0026ge;\u0026thinsp;48 mmol/mol), a fasting plasma glucose concentration (FPG) above 7.0 mmol/L, a random plasma glucose concentration surpassing 11.1 mmol/L, or a 2-hour plasma glucose (2-h PG) concentration greater than 11.1 mmol/L during an oral glucose tolerance test (OGTT)\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Blood sugar levels were rigorously controlled by insulin injections during the perioperative period with close collaboration between oncologists, surgeons, and endocrinologists.\u003c/p\u003e \u003cp\u003eNeoadjuvant therapy and surgical techniques\u003c/p\u003e \u003cp\u003eNAT included chemotherapy, radiotherapy, and immunotherapy, with the most common regimens being neoadjuvant chemoradiotherapy (nCRT) or nCRT combined with immunotherapy (nCRT\u0026thinsp;+\u0026thinsp;I). Chemoradiotherapy was administered according to the CROSS protocol\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. After 4\u0026ndash;6 weeks, patients were reassessed for contraindications and subsequently received surgery if appropriate. Esophagectomy was performed using either open or minimally invasive approaches, including McKeown or Ivor-Lewis procedures, via video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracic surgery (RATS). Two-field or three-field lymphadenectomy was performed according to tumor location and intraoperative findings.\u003c/p\u003e \u003cp\u003eOutcome measures\u003c/p\u003e \u003cp\u003eBaseline characteristics and surgical information were collected. Primary endpoints were perioperative outcomes and long-term survival. The Clavien Dindo Classification is used to rank the severity of a surgical complication. OS was measured from the date of diagnosis of esophageal cancer until death or last follow-up. Progression-free survival (PFS) was defined as the time from the date of diagnosis of esophageal cancer until the first observation of disease progression (e.g., recurrence or metastasis) or death, whichever occurred first.\u003c/p\u003e \u003cp\u003ePropensity score matching\u003c/p\u003e \u003cp\u003eTo reduce the impact of potential confounders on selection bias, a 1:4 propensity score matching (PSM) was performed between the two groups using the nearest-neighbor method with a caliper of 0.05. The most likely factors affecting the analysis results were selected, including sex, age, body mass index (BMI), other comorbidities, smoking history, alcohol consumption, neoadjuvant modality, surgical technique, histology, tumor location, tumor regression grade, pT category, pN category and pM category.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were conducted using R software (version 4.3.3; R Foundation for Statistical Computing, Vienna, Austria). The differences in baseline characteristics and perioperative outcomes between the two groups were evaluated using the χ\u0026sup2; test or Fisher\u0026rsquo;s exact test for categorical variables, t-test for continuous variables with normal distribution, and non-parametric tests for continuous variables without normal distribution, as appropriate. Survival rates were estimated using Kaplan-Meier curves and compared with log-rank tests. PSM analysis was also performed using R software. A two-sided P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003ePatient characteristics\u003c/p\u003e \u003cp\u003eA total of 1,099 patients who underwent NAT followed by surgery were included. Patients were divided into a diabetic group (n\u0026thinsp;=\u0026thinsp;114) and a non-diabetic group (n\u0026thinsp;=\u0026thinsp;985). After 1:4 propensity score matching (PSM), 114 diabetic patients were matched with 456 non-diabetic patients. In the matched cohort, the non-diabetic group comprised 376 males (82.5%) and 80 females (17.5%), while the diabetic group included 92 males (80.7%) and 22 females (19.3%). Median age was 65 years (interquartile range, 59 to 70) in the non-diabetic group and 64.5 years (interquartile range, 60 to 69) in the diabetic group.\u003c/p\u003e \u003cp\u003eBaseline characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Before matching, patients in the diabetic group had a higher body mass index (BMI) and a greater prevalence of other comorbidities compared with the non-diabetic group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); these differences were balanced after PSM. No other significant differences were observed before or after matching. All subsequent analyses were performed on the matched cohort.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBefore PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAfter PSM\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-diabetic (n\u0026thinsp;=\u0026thinsp;985)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiabetic (n\u0026thinsp;=\u0026thinsp;114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-diabetic (n\u0026thinsp;=\u0026thinsp;456)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDiabetic (n\u0026thinsp;=\u0026thinsp;114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e830(84.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92(80.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e376 (82.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e92 (80.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155(15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(19.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80 (17.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (19.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at diagnosis (yr), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.00\u003c/p\u003e \u003cp\u003e[57.00, 68.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.50\u003c/p\u003e \u003cp\u003e[60.00,69.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65.00\u003c/p\u003e \u003cp\u003e[59.00,70.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e64.50\u003c/p\u003e \u003cp\u003e[60.00,69.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m2), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.32\u003c/p\u003e \u003cp\u003e[20.57, 24.46]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.99\u003c/p\u003e \u003cp\u003e[21.27,24.95]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.03\u003c/p\u003e \u003cp\u003e[21.06,25.05]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.99\u003c/p\u003e \u003cp\u003e[21.27,24.95]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.931\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking history (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e591(60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60(52.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e251 (55.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60 (52.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.721\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking history (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e559(56.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62(54.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e252 (55.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62 (54.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.950\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther comorbidities (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e245(24.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61(53.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e211 (46.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61 (53.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCervical esophagus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper esophagus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100(10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(15.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60(13.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18(15.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle esophagus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e468(47.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(47.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e230(50.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e54(47.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower esophagus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e365(37.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e153(33.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38(33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper\u0026thinsp;+\u0026thinsp;Middle\u0026thinsp;+\u0026thinsp;Lower esophagus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(0.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEsophago-gastric junction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41(4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6(1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistology (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eESCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e903(91.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100(87.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e413 (90.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100 (87.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(2.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54(5.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(7.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (7.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant modality (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.981\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e475(48.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(43.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e203 (44.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50 (43.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRT\u0026thinsp;+\u0026thinsp;I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76(7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49 (10.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(6.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCT\u0026thinsp;+\u0026thinsp;I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e366(37.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45(39.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e186 (40.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45 (39.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor regression grade (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.961\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e351(35.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(29.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e140 (30.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (29.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e226(22.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(27.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e119 (26.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31 (27.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154(15.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e254(25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(22.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e112 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 (22.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eypTNM (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73(7.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42 (9.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e357(36.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37(32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e161 (35.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37 (32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e196(19.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e110 (24.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e281(28.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(22.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e111 (24.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 (22.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78(7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(7.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32 (7.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (7.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSurgical information\u003c/p\u003e \u003cp\u003eSurgical information are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. No statistically significant differences were observed between non-diabetic and diabetic group both before and after PSM in terms of ASA score, surgical technique, surgical margin, anastomosis location, esophageal replacement organ, number of lymph node dissection, intravascular infiltration, nerve invasion and lymphatic metastasis. Prior to PSM, a switching of surgical method was required in 16 patients (1.6%) within the non-diabetic group and in 3 patient (0.3%) in the diabetic group, primarily due to severe adhesions and anatomical variations, with no statistically significant difference (P\u0026thinsp;=\u0026thinsp;0.833). Intraoperative complications, including massive hemorrhage, cardiac arrest, and splenectomy, were reported in 3 patients (0.3%) in the non-diabetic group, while no such complications were observed in the diabetic group, with no statistically significant difference noted (P\u0026thinsp;\u0026gt;\u0026thinsp;0.99). After PSM, the results also indicate no statistically significant difference between non-diabetic and diabetic group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurgical information\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBefore PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAfter PSM\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-diabetic (n\u0026thinsp;=\u0026thinsp;985)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiabetic (n\u0026thinsp;=\u0026thinsp;114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-diabetic (n\u0026thinsp;=\u0026thinsp;456)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDiabetic (n\u0026thinsp;=\u0026thinsp;114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA score (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e654 (66.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (64.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e299 (65.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73 (64.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅢ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e291 (29.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (29.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e138 (30.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (29.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅣ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (1.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical technique (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.923\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127 (12.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61 (13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVideo-assisted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e547 (55.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (51.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e230 (50.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e59 (51.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRobot-assisted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e311 (31.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (34.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e165 (36.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39 (34.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical margin (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e959 (97.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (94.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e442 (96.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e108 (94.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastomosis location (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e849 (86.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (82.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e388 (85.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e94 (82.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEsophageal replacement organ (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.469\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTubular stomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e968 (98.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e450 (98.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e114 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of lymph node dissection (n), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.00\u003c/p\u003e \u003cp\u003e[14.00, 29.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.00\u003c/p\u003e \u003cp\u003e[14.00,30.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.00\u003c/p\u003e \u003cp\u003e[14.00,29.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.00\u003c/p\u003e \u003cp\u003e[14.00,30.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.982\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntravascular infiltration (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e142 (14.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66 (14.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e843 (85.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (88.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e390 (85.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e101 (88.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNerve invasion (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.836\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.857\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132 (13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60 (13.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e853 (86.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (88.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e396 (86.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e101 (88.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphatic metastasis (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.912\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e370 (37.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e153 (33.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37 (32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e615 (62.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (67.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e303 (66.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e77 (67.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwitching of surgical method (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative complication (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePostoperative outcomes\u003c/p\u003e \u003cp\u003ePerioperative outcomes are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. No statistically significant differences were observed between the two groups both before and after PSM in terms of length of stay (LOS), re-operation or re-admission within 30 days, total complications, specific complications (including anastomotic leakage, pleural effusion, pneumonia) and other complications.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerioperative outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBefore PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAfter PSM\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-diabetic (n\u0026thinsp;=\u0026thinsp;985)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiabetic (n\u0026thinsp;=\u0026thinsp;114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-diabetic (n\u0026thinsp;=\u0026thinsp;456)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDiabetic (n\u0026thinsp;=\u0026thinsp;114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLOS after surgery (d), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.00\u003c/p\u003e \u003cp\u003e[8.00, 12.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.00\u003c/p\u003e \u003cp\u003e[8.00, 12.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.00\u003c/p\u003e \u003cp\u003e[7.00, 12.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.00\u003c/p\u003e \u003cp\u003e[8.00, 12.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.856\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRe-operation within 30 days (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.594\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRe-admission within 30 days (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal complications (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e445 (45.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (51.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e205 (45.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e59 (51.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastomotic leakage (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.469\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅢ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(2.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅣ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePleural effusion (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113 (11.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.738\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅢ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumonia (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e177 (18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.653\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88 (19.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.937\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21 (18.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅢ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6(1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅣ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅤ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther complications (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e234 (23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (27.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98 (21.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31 (27.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter PSM, there was no significant difference in LOS after surgery between non-diabetic and diabetic group [9 days (IQR 7\u0026ndash;12 days) vs. 9 days (IQR 8\u0026ndash;12days), P\u0026thinsp;=\u0026thinsp;0.856]. Rates of 30-day reoperation (P\u0026thinsp;=\u0026thinsp;0.594) and readmission (P\u0026thinsp;\u0026gt;\u0026thinsp;0.99) were similar. Overall complication rates were comparable (45.0% vs 51.8%, P\u0026thinsp;=\u0026thinsp;0.231). No significant differences were found in anastomotic leakage (P\u0026thinsp;=\u0026thinsp;0.469), pleural effusion (P\u0026thinsp;=\u0026thinsp;0.738), pneumonia (P\u0026thinsp;=\u0026thinsp;0.937), or other complications, including cardiac events, chylothorax, vocal cord paralysis, and wound infection (P\u0026thinsp;=\u0026thinsp;0.24).\u003c/p\u003e \u003cp\u003eSurvival outcomes\u003c/p\u003e \u003cp\u003eAfter PSM, median follow-up was 1,086 days (95% CI 1,079\u0026ndash;1,090). The 2-year overall survival (OS) rate was 73.9% (95% CI 69.7\u0026ndash;78.4%) in the non-diabetic group and 77.2% (95% CI 69.4\u0026ndash;85.9%) in the diabetic group; 3-year OS rates were 62.4% (95% CI 57.4\u0026ndash;67.7%) and 67.8% (95% CI 58.7\u0026ndash;78.3%), respectively. The hazard ratio (HR) for OS was 0.84 (95% CI 0.57\u0026ndash;1.22; P\u0026thinsp;=\u0026thinsp;0.356), indicating no significant difference between groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMedian follow-up for progression-free survival (PFS) was 927 days (95% CI 907\u0026ndash;1,078). The 2-year PFS rate was 73.2% (95% CI 68.8\u0026ndash;77.9%) in non-diabetic patients versus 65.1% (95% CI 56.1\u0026ndash;75.7%) in diabetic patients; 3-year PFS rates were 65.2% (95% CI 60.1\u0026ndash;70.8%) and 62.4% (95% CI 53.1\u0026ndash;73.3%), respectively. The HR for PFS was 1.13 (95% CI 0.78\u0026ndash;1.63; P\u0026thinsp;=\u0026thinsp;0.529), with no statistically significant difference (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the impact of type 2 diabetes mellitus (T2DM) on perioperative outcomes and long-term survival in esophageal cancer patients undergoing NAT followed by surgery, using propensity score matching (PSM) to minimize confounding.\u003c/p\u003e \u003cp\u003eThe similar incidence of perioperative complications between the two groups reinforces the notion that diabetes may not substantially increase immediate surgical risks. This finding aligns with prior studies emphasizing the importance of perioperative glycemic control and a multidisciplinary approach in minimizing complications for diabetic patients undergoing major surgeries\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. The ADA recommends maintaining perioperative blood glucose between 80\u0026ndash;180 mg/dL, with tighter control in critically ill patients\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Optimal management involves preoperative identification of poorly controlled diabetes, intraoperative glucose monitoring, and postoperative strategies to avoid both hyper- and hypoglycemia. Collaboration among endocrinologists, anesthesiologists, and surgeons appears to improve outcomes in diabetic patients undergoing complex procedures.\u003c/p\u003e \u003cp\u003eLong-term outcomes, including OS and PFS, were also similar between groups, indicating that T2DM may not independently compromise survival. These findings contrast with some studies reporting worse outcomes in diabetic cancer patients\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Several factors may explain the inconsistency in the conclusions across studies. Patient characteristics, for example, can vary significantly. Some studies have included individuals with a longer duration of diabetes or pre-existing cardiovascular disease, which may have contributed to higher mortality and poorer postoperative outcomes. Additionally, the heterogeneity within diabetic populations\u0026mdash;ranging from well-controlled early-stage diabetes to poorly controlled, long-standing diabetes, adds complexity to understanding the true impact of diabetes on cancer outcomes. Studies focusing on well-controlled diabetic patients are likely to report more favorable results compared to those involving a more diverse group with varying levels of disease control. Treatment protocols also play a crucial role. Diabetic patients may exhibit lower adherence to recommended cancer therapies, such as chemotherapy and radiotherapy, possibly due to comorbidities or concerns regarding treatment-related side effects.\u003c/p\u003e \u003cp\u003eOur findings suggest that with appropriate management, diabetic patients can achieve outcomes similar to their non-diabetic counterparts. Meanwhile, several limitations must be acknowledged. First, although PSM was employed, residual confounding from unmeasured factors may still persist. Second, information on duration of diabetes, HbA1c trajectory and medication use was not uniformly available, which may limit our ability to stratify patients by diabetes severity. Finally, the retrospective design has inherent biases. Future multi-center, prospective studies are needed to validate these findings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e In conclusion, T2DM does not appear to compromise perioperative safety or long-term survival in esophageal cancer patients undergoing NAT followed by surgery. These findings provide reassurance that with appropriate multidisciplinary management, diabetic patients can achieve comparable outcomes to their non-diabetic counterparts.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e2-h PG\u0026nbsp;\u0026nbsp;\u0026nbsp; 2-hour Plasma Glucose\u003c/p\u003e\n\u003cp\u003eADA\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; American Diabetes Association\u003c/p\u003e\n\u003cp\u003eASA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; American Society of Anesthesiologists\u003c/p\u003e\n\u003cp\u003eBMI\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp;Body Mass Index\u003c/p\u003e\n\u003cp\u003eCI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; Confidence Interval\u003c/p\u003e\n\u003cp\u003eEC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Esophageal Cancer\u003c/p\u003e\n\u003cp\u003eESCC\u0026nbsp; \u0026nbsp; \u0026nbsp;Esophageal Squamous Cell Carcinoma\u003c/p\u003e\n\u003cp\u003eFPG\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; Fasting Plasma Glucose\u003c/p\u003e\n\u003cp\u003eHbA1c \u0026nbsp; Hemoglobin A1c\u003c/p\u003e\n\u003cp\u003eHR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Hazard Ratio\u003c/p\u003e\n\u003cp\u003eIDF \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;International Diabetes Federation\u003c/p\u003e\n\u003cp\u003eIQR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; Interquartile Range\u003c/p\u003e\n\u003cp\u003eIRB\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; Institutional Review Board\u003c/p\u003e\n\u003cp\u003eLOS \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp;Length of Stay\u003c/p\u003e\n\u003cp\u003eNAT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; Neoadjuvant Therapy\u003c/p\u003e\n\u003cp\u003enCRT\u0026nbsp; \u0026nbsp;\u0026nbsp;Neoadjuvant Chemoradiotherapy\u003c/p\u003e\n\u003cp\u003enCRT+I\u0026nbsp;Neoadjuvant Chemoradiotherapy combined with Immunotherapy\u003c/p\u003e\n\u003cp\u003eOGTT\u0026nbsp; \u0026nbsp;Oral Glucose Tolerance Test\u003c/p\u003e\n\u003cp\u003eOS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp;Overall Survival\u003c/p\u003e\n\u003cp\u003ePFS \u0026nbsp; Progression-Free Survival\u003c/p\u003e\n\u003cp\u003ePSM\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Propensity Score Matching\u003c/p\u003e\n\u003cp\u003eRATS \u0026nbsp; Rrobotic-assisted thoracic surgery\u003c/p\u003e\n\u003cp\u003eVATS\u0026nbsp; \u0026nbsp; \u0026nbsp;Video-assisted thoracoscopic surgery\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eT2DM \u0026nbsp;Type 2 Diabetes Mellitus\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003e This study was approved by the Ethics Committee of the three Hospitals (IRB number: KY-202425, October 15, 2024). Written informed consent was waived.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003e All authors have consented to the publication of this manuscript and guarantee that the data and results presented are accurate and reliable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis study was supported by the National Natural Science Foundation of China (82372855, 82072557 and 82472663), National Key Research and Development Program of China (2021YFC2500900), Shanghai Municipal Education Commission - Gaofeng Clinical Medicine Grant (20172005, the 2nd round of disbursement), program of Shanghai Academic Research Leader from Science and Technology Commission of Shanghai Municipality (20XD1402300), Novel Interdisciplinary Research Project from Shanghai Municipal Health Commission (2022JC023), Interdisciplinary Program of Shanghai Jiao Tong University (YG2023ZD04), Clinical Research Project in Health Services of Shanghai Municipal Health Commission (202240089) and National Translational Medicine Center (Shanghai) Open Project (NRCTM(SH)-2025-12).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: Hecheng Li, Yuqin Cao, Yongtao Han, Zhigang LiData Curation: Xipeng Wang, Xuefeng Leng, Zhichao Liu, Jingwen Zhang, Xiaoting YuFormal analysis: Xipeng Wang, Yuqin Cao, Zhichao LiuFunding acquisition: Hecheng Li, Yongtao Han, Zhigang LiInvestigation: Xipeng Wang, Xuefeng Leng, Zhichao Liu, Xinmin Li, Jingwen Zhang, Xiaoting YuMethodology: Xipeng Wang, Yuqin Cao, Zhichao LiuProject administration: Hecheng Li, Yuqin Cao, Yongtao Han, Zhigang LiResources: Xinmin Li, Jingwen Zhang, Xiaoting Yu, Chengqiang Li, Wei GuoSoftware: Xipeng Wang, Xinmin Li, Jingwen Zhang, Xiaoting Yu, Yuqin CaoSupervision: Hecheng Li, Yuqin Cao, Yongtao Han, Zhigang LiValidation: Xuefeng Leng, Zhichao Liu, Wei Guo, Chengqiang LiVisualization: Xipeng Wang, Xinmin Li, Jingwen Zhang, Xiaoting YuWriting \u0026ndash; original draft: Xipeng Wang, Xuefeng Leng, Zhichao LiuWriting \u0026ndash; review \u0026amp; editing: Hecheng Li, Yuqin Cao, Yongtao Han, Zhigang Li, Chengqiang Li, Wei Guo\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e \u003cp\u003eNone.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials:\u003c/h2\u003e \u003cp\u003eThe data underlying this article cannot be shared publicly for the privacy of individuals that participated in the study. The data may be shared on reasonable request to the corresponding author.\u003c/p\u003e \u003cp\u003eCompeting interests: No conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin May-Jun. 2024;74(3):229\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3322/caac.21834\u003c/span\u003e\u003cspan address=\"10.3322/caac.21834\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalhotra GK, Yanala U, Ravipati A, Follet M, Vijayakumar M, Are C. Global trends in esophageal cancer. 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Br J Anaesth Jul. 2024;133(1):67\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bja.2024.04.010\u003c/span\u003e\u003cspan address=\"10.1016/j.bja.2024.04.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Esophageal Neoplasms, Esophagectomy, Neoadjuvant Therapy, Type 2 Diabetes Mellitus","lastPublishedDoi":"10.21203/rs.3.rs-8458597/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8458597/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAfter 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\u0026thinsp;=\u0026thinsp;0.856), re-operation (2.2% vs 0.9%, P\u0026thinsp;=\u0026thinsp;0.594), re-admission (1.5% vs 1.8%, P\u0026thinsp;\u0026gt;\u0026thinsp;0.990), total complications (45.0% vs 51.8%, P\u0026thinsp;=\u0026thinsp;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\u0026ndash;1.220, P\u0026thinsp;=\u0026thinsp;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\u0026ndash;1.630, P\u0026thinsp;=\u0026thinsp;0.529].\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eType 2 diabetes does not adversely affect perioperative outcomes or long-term survival in esophageal cancer patients undergoing neoadjuvant therapy and surgery.\u003c/p\u003e","manuscriptTitle":"Impact of type 2 diabetes on the outcomes of neoadjuvant therapy followed by surgery for esophageal cancer: a multi-center retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-17 14:49:19","doi":"10.21203/rs.3.rs-8458597/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-20T08:39:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"315929670133358042591606649385735372213","date":"2026-04-17T17:35:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-11T20:22:12+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-29T15:32:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-29T05:36:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-29T05:34:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2025-12-27T04:43:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"36b19cde-7217-4282-b425-e34e1f56827e","owner":[],"postedDate":"February 17th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-17T14:49:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-17 14:49:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8458597","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8458597","identity":"rs-8458597","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}