Impact of intraoperative blood loss on survival after curative resection for gastric cancer
Impact of intraoperative blood loss on survival after curative resection for gastric cancer
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DOI：
10.3748/wjg.v19.i33.5542
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发表时间：
2013-09-07
影响因子：
4.3
通讯作者：
Liang, Han
中科院分区：
文献类型：
--
作者：
Liang, Yue-Xiang;Guo, Han-Han;Liang, Han
目的：探讨术中出血量（IBL）对胃癌术后患者长期生存的潜在影响。方法：本研究共纳入2003年1月至2007年12月在我中心行根治性胃切除术的I-III期胃癌患者845例。根据IBL量将患者分为3组：1组（< 200 mL）、2组（200 ~ 400 mL）、3组（bb0 ~ 400 mL）。比较三组患者的临床病理特征，并分析潜在的预后因素。采用Log-rank检验评估组间的统计学差异。通过Cox比例风险回归模型确定独立预后因素。分层分析IBL对各期患者生存的影响。通过排除胃癌以外的死亡原因，还比较了三组患者的癌症特异性生存率。最后，我们探讨了与IBL相关的可能因素，并确定了IBL的独立危险因素>= 200 ml。结果：IBL数量对总生存率有显著影响。IBL小于200 mL、200 ~ 400 mL和大于400 mL的5年总生存率分别为51.2%、39.4%和23.4% （< 200 mL vs 200 ~ 400 mL, P < 0.001; 200 ~ 400 mL vs > 400 mL, P = 0.003）。多变量分析发现年龄、肿瘤大小、Borrmann型、结外转移、TNM分期、化疗、淋巴结切除程度、IBL和术后并发症是独立的预后因素。分层分析发现，分期为TNM I-II和IBL小于200 mL的患者往往比分期为TNM的IBL不小于200 mL的患者有更好的生存。IBL小于400 mL的患者生存率较高。肿瘤位置、肿瘤大小、TNM分期、胃切除类型、联合脏器切除、淋巴结切除程度、手术年份是IBL数量的相关因素，而肿瘤位置、胃切除类型、联合脏器切除、手术年份与IBL >= 200 ml独立相关。结论：IBL是胃癌根治性切除后的独立预后因素。减少IBL可改善胃癌根治性胃切除术后患者的远期预后。(三)2013年白石登。版权所有。
AIM: To elucidate the potential impact of intraoperative blood loss (IBL) on long-term survival of gastric cancer patients after curative surgery.METHODS: A total of 845 stage I-III gastric cancer patients who underwent curative gastrectomy between January 2003 and December 2007 in our center were enrolled in this study. Patients were divided into 3 groups according to the amount of IBL: group 1 (< 200 mL), group 2 (200-400 mL) and group 3 (> 400 mL). Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed. The Log-rank test was used to assess statistical differences between the groups. Independent prognostic factors were identified by the Cox proportional hazards regression model. Stratified analysis was used to investigate the impact of IBL on survival in each stage. Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer. Finally, we explored the possible factors associated with IBL and identified the independent risk factors for IBL >= 200 mL.RESULTS: Overall survival was significantly influenced by the amount of IBL. The 5-year overall survival rates were 51.2%, 39.4% and 23.4% for IBL less than 200 mL, 200 to 400 mL and more than 400 mL, respectively (< 200 mL vs 200-400 mL, P < 0.001; 200-400 mL vs > 400 mL, P = 0.003). Age, tumor size, Borrmann type, extranodal metastasis, tumour-node-metastasis (TNM) stage, chemotherapy, extent of lymphadenectomy, IBL and postoperative complications were found to be independent prognostic factors in multivariable analysis. Following stratified analysis, patients staged TNM I-II and those with IBL less than 200 mL tended to have better survival than those with IBL not less than 200 mL, while patients staged TNM., whose IBL was less than 400 mL had better survival. Tumor location, tumor size, TNM stage, type of gastrectomy, combined organ resection, extent of lymphadenectomy and year of surgery were found to be factors associated with the amount of IBL, while tumor location, type of gastrectomy, combined organ resection and year of surgery were independently associated with IBL >= 200 mL.CONCLUSION: IBL is an independent prognostic factor for gastric cancer after curative resection. Reducing IBL can improve the long-term outcome of gastric cancer patients following curative gastrectomy. (C) 2013 Baishideng. All rights reserved.