Impact of postoperative complications on survival outcomes in patients with gastric cancer: exploratory analysis of a randomized controlled JCOG1001 trial.


Journal

Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association
ISSN: 1436-3305
Titre abrégé: Gastric Cancer
Pays: Japan
ID NLM: 100886238

Informations de publication

Date de publication:
Jan 2021
Historique:
received: 12 03 2020
accepted: 20 06 2020
pubmed: 1 7 2020
medline: 11 11 2021
entrez: 1 7 2020
Statut: ppublish

Résumé

Recent studies have found a negative impact of postoperative complications on long-term survival outcomes, but it has not been confirmed by data obtained from a prospective study with a large sample size. This study investigated the impact of postoperative complications on long-term survival outcomes, and considered the optimal definition of complication, using data from JCOG1001, which compared bursectomy and non-bursectomy for patients with cT3/4a locally advanced gastric cancer. This study included 1191 of 1204 patients enrolled in the JCOG1001 trial. Complications were graded by Clavien-Dindo (C-D) classification. Impact of the grade (≥ C-D grade II or ≥ grade III) or type (any or intra-abdominal infectious) of complication on survival outcome was evaluated by univariate and multivariable analyses using the Cox proportional hazard model. The incidence of any ≥ C-D grade II and ≥ grade III complication was 23.0% and 9.7%, respectively, and that of ≥ grade II and ≥ grade III intra-abdominal infectious complication was 13.4% and 6.9%, respectively. Multivariable analysis showed all four definitions of complications were independent prognostic factors for overall survival. Conversely, only  any ≥ C-D grade III complication was found to be an independent prognostic factor for relapse-free survival (hazard ratio, 1.445; 95% confidence interval, 1.026-2.036; P = 0.035). Postoperative complications adversely affect the long-term survival outcomes of patients with cT3/4a gastric cancer. Any ≥ C-D grade III complication seems to be the most suitable definition of complication for predicting negative long-term survival outcomes.

Sections du résumé

BACKGROUND BACKGROUND
Recent studies have found a negative impact of postoperative complications on long-term survival outcomes, but it has not been confirmed by data obtained from a prospective study with a large sample size. This study investigated the impact of postoperative complications on long-term survival outcomes, and considered the optimal definition of complication, using data from JCOG1001, which compared bursectomy and non-bursectomy for patients with cT3/4a locally advanced gastric cancer.
METHODS METHODS
This study included 1191 of 1204 patients enrolled in the JCOG1001 trial. Complications were graded by Clavien-Dindo (C-D) classification. Impact of the grade (≥ C-D grade II or ≥ grade III) or type (any or intra-abdominal infectious) of complication on survival outcome was evaluated by univariate and multivariable analyses using the Cox proportional hazard model.
RESULTS RESULTS
The incidence of any ≥ C-D grade II and ≥ grade III complication was 23.0% and 9.7%, respectively, and that of ≥ grade II and ≥ grade III intra-abdominal infectious complication was 13.4% and 6.9%, respectively. Multivariable analysis showed all four definitions of complications were independent prognostic factors for overall survival. Conversely, only  any ≥ C-D grade III complication was found to be an independent prognostic factor for relapse-free survival (hazard ratio, 1.445; 95% confidence interval, 1.026-2.036; P = 0.035).
CONCLUSIONS CONCLUSIONS
Postoperative complications adversely affect the long-term survival outcomes of patients with cT3/4a gastric cancer. Any ≥ C-D grade III complication seems to be the most suitable definition of complication for predicting negative long-term survival outcomes.

Identifiants

pubmed: 32601909
doi: 10.1007/s10120-020-01102-3
pii: 10.1007/s10120-020-01102-3
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

214-223

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Auteurs

Masanori Tokunaga (M)

Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan. tokunaga.srg1@tmd.ac.jp.

Yukinori Kurokawa (Y)

Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.

Ryunosuke Machida (R)

Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Centre Hospital, Tokyo, Japan.

Yuya Sato (Y)

Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Centre Hospital, Tokyo, Japan.

Shuji Takiguchi (S)

Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.

Yuichiro Doki (Y)

Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.

Hiroshi Yabusaki (H)

Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan.

Masaya Watanabe (M)

Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan.

Shinji Hato (S)

Department of Gastroenterological Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.

Mikihito Nakamori (M)

Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.

Seiji Ito (S)

Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.

Takaki Yoshikawa (T)

Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan.

Masanori Terashima (M)

Division of Gastric Surgery, Shizuoka Cancer Center, Nagaizumi, Japan.

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