Department of Surgery, Nara Medical University, Kashihara, Nara, Japan.
Department of Surgery, Nara Medical University, Kashihara, Nara, Japan.
J Surg Res. 2019 Oct;242:323-331. doi: 10.1016/j.jss.2019.04.075. Epub 2019 May 23.
The aim of this study was to investigate the prognostic impact of postoperative systemic inflammation in patients with stage I gastric cancer.
This study reviewed the medical records of 470 patients with stage I gastric cancer who underwent gastrectomy. The postoperative serum C-reactive protein (CRP) level on postoperative days (PODs) 1 and 3 and its peak value were evaluated as prognostic factors. A receiver operating characteristics curve analysis was performed to determine their cut-off values.
The CRP level on POD 3 (P = 0.001) and the peak CRP level (P = 0.007) were significantly associated with the overall survival rate. In the multivariate analysis, the CRP level on POD 3 (P = 0.002) and the peak CRP level (P = 0.008) were identified as independent predictors of the overall survival. The high CRP on POD3 group had significantly higher mortality rate from relapse of gastric cancer (P = 0.001) and infectious disease (P = 0.003) than the low CRP on POD 3 group. The CRP level on POD 3 was significantly associated with the patient sex, surgical procedure, duration of the operation, amount of blood loss, postoperative infectious complication, and peak CRP level.
The serum CRP level during the early postoperative period predicts the long-term outcomes in stage I gastric cancer. The present study suggests a significant influence of postoperative systemic inflammation on the survival of patients with stage I gastric cancer.
本研究旨在探讨术后全身炎症对 I 期胃癌患者的预后影响。
本研究回顾性分析了 470 例行胃癌根治术的 I 期胃癌患者的病历资料。评估术后第 1 天和第 3 天的血清 C 反应蛋白（CRP）水平及其峰值作为预后因素。采用受试者工作特征曲线分析确定其截断值。
术后第 3 天的 CRP 水平（P=0.001）和峰值 CRP 水平（P=0.007）与总生存率显著相关。多因素分析显示，术后第 3 天的 CRP 水平（P=0.002）和峰值 CRP 水平（P=0.008）是总生存率的独立预测因素。术后第 3 天 CRP 升高组胃癌复发（P=0.001）和感染性疾病（P=0.003）的死亡率明显高于 CRP 正常组。术后第 3 天的 CRP 水平与患者性别、手术方式、手术时间、出血量、术后感染并发症和峰值 CRP 水平显著相关。
术后早期血清 CRP 水平可预测 I 期胃癌患者的长期预后。本研究提示术后全身炎症对 I 期胃癌患者的生存有显著影响。
