Prognostic Impact of Postoperative Morbidity After Esophagectomy for Esophageal Cancer Exploratory Analysis of JCOG9907
Prognostic Impact of Postoperative Morbidity After Esophagectomy for Esophageal Cancer Exploratory Analysis of JCOG9907
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DOI：
10.1097/sla.0000000000001828
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发表时间：
2017-06-01
影响因子：
9
通讯作者：
Kitagawa, Yuko
中科院分区：
文献类型：
--
作者：
Kataoka, Kozo;Takeuchi, Hiroya;Kitagawa, Yuko
目的：为了研究感染并发症对目前标准术前化疗的结果的影响，然后手术治疗临床II/III期食管癌。背景：术后感染并发症对经胸食管切除术后生存率的影响仍然存在争议。方法：数据来自一项随机对照试验（JCOG 9907）。感染并发症分为三组：肺炎、吻合口瘘和其他。结果：在152例分析的患者中，肺炎、渗漏和总体感染并发症的发生率分别为22例（14%）、21例（14%）和54例（36%）。有任何感染并发症的患者的总生存期（OS）短于无感染并发症的患者[风险比，HR 1.66，95%置信区间，CI，（1.02-2.71）]，有任何感染并发症的患者的无进展生存期（PFS）也倾向于较短[HR 1.44，（0.92-2.24）]。肺炎患者的OS短于非肺炎患者[HR 1.82，（1.01-3.29）]，肺炎患者的PFS也有缩短的趋势[HR 1.50，（0.85-2.62）]。发生吻合口瘘的患者（n = 21）的OS与无吻合口瘘的患者几乎相同[HR 1.06，（0.52-2.13）]，PFS显示出相同的趋势[HR 1.28，（0.71-2.32）]。多因素分析显示，感染性并发症对食管癌患者的生存率和无进展生存率有影响[HR 1.66，（0.87-3.17）和HR 1.37，（0.75-2.51）]。无术后并发症，特别是肺炎，进行食管切除术，可能有利于提高生存率。
Objective: To investigate the influence of infectious complications on the outcome of current standard preoperative chemotherapy followed by surgery for clinical stage II/III esophageal cancer.Background: The impact of postoperative infectious complications on survival after transthoracic esophagectomy remains controversial.Methods: Data from a randomized controlled trial (JCOG9907) were used. Infectious complications were classified into three groups: pneumonia, anastomotic leakage, and others. Univariate and multivariate analyses using the Cox proportional hazard model were performed.Results: Among the 152 analyzed patients, the incidence of pneumonia, leakage, and overall infectious complication were 22 (14%), 21 (14%), and 54 (36%). Overall survival (OS) of patients with any infectious complication was shorter than that of patients without infectious complication [hazard ratio, HR 1.66, 95% confidence interval, CI, (1.02-2.71)] and progression-free survival (PFS) also tended to be shorter in patients with any infectious complication [HR 1.44, (0.92-2.24)]. The OS of patients with pneumonia was shorter than that of patients without pneumonia [HR 1.82, (1.01-3.29)], and PFS also tended to be shorter in patients with pneumonia [HR 1.50, (0.85-2.62)]. The OS of patients with anastomotic leakage (n = 21) was nearly identical to that for patients without leakage [HR 1.06, (0.52-2.13)] and PFS showed the same tendency [HR 1.28, (0.71-2.32)]. Multivariate analysis revealed that pneumonia tended to compromise OS and PFS [HR 1.66, (0.87-3.17) and HR 1.37, (0.75-2.51)].Conclusions: These results indicate that postoperative infectious complications may worsen patient prognosis after esophagectomy. Performing esophagectomy without postoperative complications, especially pneumonia, may be beneficial for improving survival outcomes.