II/III期胃癌患者胃切除术后并发症的不良预后影响：对前瞻性收集的真实世界数据的分析
Adverse Prognostic Impact of Postoperative Complications After Gastrectomy for Patients With Stage II/III Gastric Cancer: Analysis of Prospectively Collected Real-World Data.
作者信息
Song Jeong Ho, Lee Sejin, Choi Seohee, Cho Minah, Kwon In Gyu, Kim Yoo Min, Son Taeil, Kim Hyoung-Il, Jung Minkyu, Hyung Woo Jin
机构信息
Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.
出版信息
Front Oncol. 2021 Apr 29;11:611510. doi: 10.3389/fonc.2021.611510. eCollection 2021.
BACKGROUND
The impact of postoperative complications on the prognosis of gastric cancer remains controversial. This study aimed to evaluate the relationship between postoperative complications and long-term survival in patients undergoing gastrectomy for stage II/III gastric cancer.
METHODS
Some 939 patients underwent curative gastrectomy for stage II/III gastric cancer were identified from real-world data prospectively collected between 2013 and 2015. We divided patients according to the presence of serious complications, specifically, Clavien-Dindo grade III or higher complications or those causing a hospital stay of 15 days or longer.
RESULTS
Serious complications occurred in 125 (13.3%) patients. Patients without serious complications (64.3%) completed adjuvant chemotherapy significantly more than patients with serious complications (37.6%; p<0.001). The 5-year overall survival(OS) rate was 58.1% and recurrence-free survival(RFS) rate was 58.1% in patients with serious complications, which were significantly worse than those of patients without serious complications (73.4% and 74.7%, respectively; p<0.001 for both). In stage II, once patients completed adjuvant chemotherapy adequately, the OS and RFS of patients with serious complications did not differ from those without serious complications. However, in stage III, the patients with serious complications showed a worse OS even after completion of adequate adjuvant chemotherapy.
CONCLUSION
Serious complications after gastrectomy had a negative impact on the prognosis of stage II/III gastric cancer patients. Serious complications worsen the survival in association with inadequate adjuvant chemotherapy. Efforts to reduce serious complications, as well as support adequate chemotherapy through proper management of serious complications, would improve the prognosis of stage II/III gastric cancer patients.
背景
术后并发症对胃癌预后的影响仍存在争议。本研究旨在评估接受II/III期胃癌胃切除术患者的术后并发症与长期生存之间的关系。
方法
从2013年至2015年前瞻性收集的真实世界数据中，确定了939例行II/III期胃癌根治性胃切除术的患者。我们根据严重并发症的存在情况对患者进行分组，具体为Clavien-Dindo III级或更高等级的并发症，或导致住院15天或更长时间的并发症。
结果
125例（13.3%）患者发生严重并发症。无严重并发症的患者（64.3%）完成辅助化疗的比例显著高于有严重并发症的患者（37.6%；p<0.001）。有严重并发症患者的5年总生存率（OS）为58.1%，无复发生存率（RFS）为58.1%，均显著低于无严重并发症的患者（分别为73.4%和74.7%；两者p均<0.001）。在II期，一旦患者充分完成辅助化疗，有严重并发症患者的OS和RFS与无严重并发症患者无差异。然而，在III期，即使完成了充分的辅助化疗，有严重并发症的患者OS仍较差。
结论
胃切除术后的严重并发症对II/III期胃癌患者的预后有负面影响。严重并发症会因辅助化疗不足而使生存情况恶化。减少严重并发症的努力，以及通过对严重并发症的妥善管理来支持充分化疗，将改善II/III期胃癌患者的预后。
Zotero 插件