Department of Surgery, Fukuoka Sanno Hospital, 3-6-45 Momochi-hama, Sawara-ku, Fukuoka, 814-0001, Japan.
Department of Gastroenterological Surgery, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
J Cancer Res Clin Oncol. 2020 May;146(5):1351-1360. doi: 10.1007/s00432-020-03173-2. Epub 2020 Mar 17.
The relationship between postoperative complications and long-term survival after surgery for esophageal squamous cell carcinoma (ESCC) is controversial.
A total of 210 patients with ESCC who underwent subtotal esophagectomy with a reconstructed gastric tube were investigated according to the development of postoperative complications. The associations of age, gender, T and N factors, and pStage with grade 0-2 complications (NSC) and grade 3 and higher complications (SC) were compared by propensity score-matching analysis. Fifty-one pairs of NSC and SC groups were selected for the final analysis. We divided 102 patients between the NSC and SC groups or between the no pulmonary complication (NPC) and the pulmonary complication (PC) groups. The overall survival (OS) and disease-free survival (DFS) were determined by the Kaplan-Meier method and were compared by log-rank tests. Possible predictors of OS and DFS were subjected to univariate analysis and multivariate Cox proportional hazard regression analysis.
The propensity score matching revealed that the 5-year OS and DFS of the NSC group were not different from those of the SC group. However, the 5-year OS of the PC group was significantly worse than that of the NPC group, while no significant differences were observed in the DFS between the PC and NPC groups. In the multivariate analysis, UICC pStage, pulmonary complication, and American Heart Association (AHA) classification for OS and UICC pStage for DFS were significant prognostic factors.
The OS and DFS did not differ in patients with or without severe postoperative complications. However, postoperative pulmonary complications were independent predictors of poorer OS, but not DFS, in patients who underwent R0 resection for ESCC.
食管癌（ESCC）手术后并发症与长期生存之间的关系存在争议。
根据术后并发症的发生情况，对 210 例接受胃管重建的食管鳞癌患者进行了研究。采用倾向评分匹配分析比较了年龄、性别、T 和 N 因素以及 pStage 与 0-2 级并发症（NSC）和 3 级及以上并发症（SC）的关系。最终对 51 对 NSC 和 SC 组进行了分析。我们将 102 例患者分为 NSC 和 SC 组或无肺部并发症（NPC）和肺部并发症（PC）组。采用 Kaplan-Meier 法计算总生存（OS）和无病生存（DFS），并用对数秩检验比较。对可能影响 OS 和 DFS 的因素进行单因素和多因素 Cox 比例风险回归分析。
倾向评分匹配显示，NSC 组的 5 年 OS 和 DFS 与 SC 组无差异。然而，PC 组的 5 年 OS 明显差于 NPC 组，而 PC 组和 NPC 组之间的 DFS 无显著差异。多因素分析显示，UICC pStage、肺部并发症和美国心脏协会（AHA）分类是 OS 的独立预后因素，而 UICC pStage 是 DFS 的独立预后因素。
严重术后并发症患者与无严重术后并发症患者的 OS 和 DFS 无差异。然而，对于接受 R0 切除的 ESCC 患者，术后肺部并发症是 OS 而非 DFS 的独立预后因素。
