Postoperative Complications have Minimal Impact on Long-Term Prognosis in Immunodeficient Patients with Esophageal Cancer
Postoperative Complications have Minimal Impact on Long-Term Prognosis in Immunodeficient Patients with Esophageal Cancer
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DOI：
10.1245/s10434-020-08245-8
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发表时间：
2020-02-11
影响因子：
3.7
通讯作者：
Ichikawa, Daisuke
中科院分区：
文献类型：
--
作者：
Maruyama, Suguru;Kawaguchi, Yoshihiko;Ichikawa, Daisuke
背景：在各种类型的癌症中，术后并发症已被认为对预后有不良影响。然而，在最近的一项研究中，有报道称全胃切除合并脾切除术的术后并发症对胃癌患者的长期预后影响不大。此外，术后并发症对预后影响的机制仍有待阐明。我们假设术后并发症引起的免疫抑制可能影响食管癌患者的长期预后。方法回顾性分析我院153例食管癌根治性食管次全切除术患者的术后并发症、多种临床病理因素及远期预后与淋巴细胞总计数（TLC）分层的关系。结果术前TLC中位数为1432。共有115例（75.2%）患者的TLC为>= 1000/mu L（高TLC组），其余38例（24.8%）患者的TLC < 1000/mu L（低TLC组）。153例中出现术后并发症39例（25.5%）。两组患者术后并发症与任何临床病理因素均无显著相关性。在高TLC组中，术后并发症患者的总生存率和无病生存率明显低于无并发症患者（p < 0.001和p < 0.01）。在低TLC组中，有无术后并发症的患者生存率无差异。结论：术后并发症对免疫缺陷患者的远期预后影响不大。
Background Postoperative complications have been recognized to have an adverse prognostic impact in various types of cancer. However, in a recent study, it has been reported that postoperative complications of total gastrectomy with splenectomy have little impact on the long-term outcomes of patients with gastric cancer. In addition, the mechanisms underlying the effect of postoperative complications on outcomes remain to be elucidated. We hypothesized that immunosuppression by postoperative complications may affect long-term outcomes in patients with esophageal cancer. Methods In this retrospective study, we assessed in 153 patients with esophageal cancer who underwent curative subtotal esophagectomy at our hospital and examined the correlation between postoperative complications, and multiple clinicopathological factors, and long-term outcomes with the patients stratified by total lymphocyte count (TLC). Results The median preoperative TLC was 1432. A total of 115 patients (75.2%) had a TLC of >= 1000/mu L (high TLC group), and the remaining 38 patients (24.8%) had a TLC of < 1000/mu L (low TLC group). Postoperative complications occurred in 39 of 153 cases (25.5%). There was no significant correlation between postoperative complications and any of the clinicopathological factors in either group. In the high TLC group, patients with postoperative complications had significantly lower overall and disease-free survival rates compared with those without complications (p < 0.001 and p < 0.01, respectively). In the low TLC group, no survival difference between patients with and without postoperative complications was observed. Conclusions Postoperative complications may have a minimal impact on long-term outcomes in immunodeficient patients.