Fujiya Keiichi, Tokunaga Masanori, Mori Keita, Makuuchi Rie, Tanizawa Yutaka, Bando Etsuro, Kawamura Taiichi, Terashima Masanori
Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Clinical Trial Research Center, Shizuoka Cancer Center, Shizuoka, Japan.
Ann Surg Oncol. 2016 Dec;23(Suppl 5):809-816. doi: 10.1245/s10434-016-5577-5. Epub 2016 Sep 19.
It has been reported that postoperative complications after curative surgery for gastric cancer adversely affect long-term survival; however, postoperative complications may confound other patient characteristics or tumor factors associated with survival outcome. In the present study, covariates were adjusted by propensity score matching to clarify whether postoperative complications truly affect survival outcome.
The present study was performed on 1541 patients who underwent curative gastrectomy for gastric cancer between 2002 and 2009. Patients were divided into two groups based on the occurrence (174 patients) or absence (1367 patients) of postoperative intra-abdominal infectious complications. Survival outcomes were compared between groups using propensity score matching analysis.
Most clinicopathological characteristics differed significantly between the two groups, but these differences disappeared after propensity score matching. After matching, overall survival was significantly poorer in patients with postoperative intra-abdominal infectious complications [hazard ratio (HR) 1.43, 95 % confidence interval (CI) 1.02-2.00; p = 0.036], as was relapse-free survival (HR 1.42, 95 % CI 1.03-1.96; p = 0.034).
Intra-abdominal infectious complications adversely affected survival outcome when patients were matched by propensity scores, which included demographic data as covariates. Thus, it is important to avoid the development of intra-abdominal infectious complications to improve long-term survival.
据报道，胃癌根治性手术后的术后并发症会对长期生存产生不利影响；然而，术后并发症可能会混淆其他与生存结果相关的患者特征或肿瘤因素。在本研究中，通过倾向评分匹配对协变量进行调整，以阐明术后并发症是否真的会影响生存结果。
本研究对2002年至2009年间接受胃癌根治性胃切除术的1541例患者进行。根据术后腹腔内感染并发症的发生情况（174例患者）或未发生情况（1367例患者）将患者分为两组。使用倾向评分匹配分析比较两组之间的生存结果。
两组之间的大多数临床病理特征存在显著差异，但在倾向评分匹配后这些差异消失。匹配后，术后腹腔内感染并发症患者的总生存期显著较差[风险比（HR）1.43，95%置信区间（CI）1.02 - 2.00；p = 0.036]，无复发生存期也是如此（HR 1.42，95% CI 1.03 - 1.96；p = 0.034）。
当通过倾向评分对患者进行匹配时，腹腔内感染并发症对生存结果产生不利影响，倾向评分中包括人口统计学数据作为协变量。因此，避免腹腔内感染并发症的发生对于改善长期生存很重要。
