Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden Chikusa-ku, Nagoya, 464-8681, Japan.
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Gastric Cancer. 2022 Mar;25(2):459-467. doi: 10.1007/s10120-021-01266-6. Epub 2021 Nov 19.
Recent retrospective studies have shown that increased intraoperative blood loss (IBL) during curative gastrectomy for patients with advanced gastric cancer is a negative prognostic indicator for recurrence. However, there are no reliable reports assessing this with a large-scale prospective cohort. This study aimed to evaluate the impact of IBL on long-term outcomes using data from the JCOG1001 phase III trial, which was designed to determine if bursectomy led to improved survival vs. nonbursectomy in patients with cT3/4a gastric cancer.
This study included 1203 of the 1204 patients enrolled in the JCOG1001. From the tertiles of IBL (196 ml, 400 ml), we divided the patients into three groups: IBL < 200 ml representing small blood loss (SBL, n = 404), 200 ml ≤ IBL < 400 ml representing medium blood loss (MBL, n = 393), and IBL ≥ 400 ml representing large blood loss (LBL, n = 406). The impact of IBL on relapse-free survival (RFS) was evaluated with univariable comparisons and multivariable Cox regression analyses.
Three-year RFS after SBL, MBL, and LBL was 81.7%, 74.8%, and 70.6%, respectively. Multivariable analysis identified IBL, Eastern Cooperative Oncology Group performance status, pT, pN, and postoperative adjuvant chemotherapy as independent predictors of RFS. Compared with SBL as a reference, the hazard ratios of MBL and LBL were 1.461 (P = 0.012) and 1.520 (P = 0.009), respectively.
Based on the analysis of data from a large-scale prospective study, an IBL of ≥ 200 ml after curative surgery for patients with cT3/4a gastric cancer was an independent predictor of reduced RFS.
最近的回顾性研究表明，在根治性胃切除术治疗进展期胃癌患者时，术中出血量（IBL）增加是复发的负预后指标。然而，目前尚无可靠的报告使用大规模前瞻性队列评估这一点。本研究旨在使用 JCOG1001 三期试验的数据评估 IBL 对长期结果的影响，该试验旨在确定在 cT3/4a 胃癌患者中，行胆囊切除术是否比不行胆囊切除术生存获益。
本研究纳入了 JCOG1001 试验中 1204 例患者中的 1203 例。根据 IBL 的三分位数（196ml，400ml），我们将患者分为三组：IBL<200ml 表示小量失血（SBL，n=404），200ml≤IBL<400ml 表示中量失血（MBL，n=393），IBL≥400ml 表示大量失血（LBL，n=406）。使用单变量比较和多变量 Cox 回归分析评估 IBL 对无复发生存率（RFS）的影响。
SBL、MBL 和 LBL 后的 3 年 RFS 分别为 81.7%、74.8%和 70.6%。多变量分析确定 IBL、东部肿瘤协作组体能状态、pT、pN 和术后辅助化疗是 RFS 的独立预测因素。与 SBL 作为参考相比，MBL 和 LBL 的危险比分别为 1.461（P=0.012）和 1.520（P=0.009）。
基于对大规模前瞻性研究数据的分析，cT3/4a 胃癌根治性手术后 IBL≥200ml 是 RFS 降低的独立预测因素。
