Background
Methods
Patients
Surgical procedures and postoperative management
Definition of inflammation-based factors
The definition of complications
Statistical analysis
Results
Patient characteristics
Characteristics | Before matching | After matching | ||||
---|---|---|---|---|---|---|
EP group (n = 186) | NEP group (n = 440) | p value | EP group (n = 178) | NEP group (n = 175) | p value | |
Age (years) | 80.0 ± 4.1 | 62.6 ± 9.5 | < 0.001 | 80.2 ± 4.0 | 63.8 ± 9.0 | < 0.001 |
Sex | 0.206 | 0.473 | ||||
Male | 127 (68.3) | 323 (73.4) | 123 (69.1) | 127 (72.6) | ||
Female | 59 (31.7) | 117 (26.6) | 55 (30.9) | 48 (27.4) | ||
CCI | < 0.001 | 0.002 | ||||
Low | 65 (34.9) | 243 (55.2) | 64 (36.0) | 91 (52.0) | ||
Moderate/severe | 121 (65.1) | 197 (44.8) | 114 (64.0) | 84 (48.0) | ||
mFI | 0.074 ± 0.068 | 0.046 ± 0.061 | < 0.001 | 0.073 ± 0.067 | 0.050 ± 0.064 | < 0.001 |
Number of analyzed lymph nodes | 0.577 | |||||
< 16 | 8 (4.3) | 21 (4.7) | 0 | 0 | ||
≥16 | 178 (95.7) | 419 (95.3) | 178 | 175 | ||
Number of positive lymph nodes | 1.75 ± 5.34 | 1.62 ± 5.90 | 0.546 | 1.70 ± 4.80 | 2.13 ± 8.04 | 0.738 |
Tumor size (mm) | 40.4 ± 25.9 | 38.9 ± 25.6 | 0.470 | 40.5 ± 25.5 | 41.3 ± 26.3 | |
Depth of tumor invasion | 0.479 | 0.956 | ||||
T1 | 115 (61.8) | 288 (65.5) | 107 (60.1) | 108 (61.7) | ||
T2 | 26 (14.0) | 49 (11.1) | 26 (14.6) | 22 (12.6) | ||
T3 | 33 (17.7) | 84 (19.1) | 33 (18.5) | 34 (19.4) | ||
T4 | 12 (6.5) | 19 (4.3) | 12 (6.8) | 11 (6.3) | ||
Lymph node metastasis | 0.765 | 0.700 | ||||
Positive | 51 (27.4) | 112 (25.5) | 49 (27.5) | 46 (26.3) | ||
Negative | 135 (72.6) | 328 (74.5) | 129 (72.5) | 129 (73.7) | ||
Histologic type | 0.005 | 0.511 | ||||
Differentiated | 116 (62.4) | 220 (50.0) | 111 (62.4) | 115 (65.7) | ||
Undifferenciated | 70 (37.6) | 220 (50.0) | 67 (37.6) | 60 (34.3) | ||
Lymphatic invasion | 0.136 | 0.845 | ||||
Positive | 110 (59.1) | 231 (52.5) | 106 (59.6) | 106 (60.6) | ||
Negative | 76 (40.9) | 209 (47.5) | 72 (40.4) | 69 (39.4) | ||
Venous invasion | 0.004 | 0.973 | ||||
Positive | 102 (54.8) | 184 (41.8) | 100 (56.2) | 98 (56.0) | ||
Negative | 84 (45.2) | 256 (58.2) | 78 (43.8) | 77 (44.0) | ||
Stage of disease | 0.550 | 0.578 | ||||
I | 124 (66.7) | 308 (70.0) | 116 (65.2) | 119 (68.0) | ||
II | 39 (21.0) | 76 (17.2) | 39 (21.9) | 31 (17.7) | ||
III | 23 (11.3) | 56 (12.8) | 23 (12.9) | 25 (14.3) | ||
Type of gastrectomy | 0.508 | 0.951 | ||||
Distal | 131 (70.4) | 325 (73.9) | 125 (70.2) | 125 (71.4) | ||
Total | 34 (18.3) | 64 (14.5) | 34 (19.1) | 33 (18.9) | ||
Proximal | 21 (11.3) | 51 (11.6) | 19 10.7) | 17 (9.7) | ||
Approach | 0.476 | 0.101 | ||||
Open | 71 (38.2) | 183 (41.6) | 67 (37.6) | 82 (46.9) | ||
Laparo | 115 (61.8) | 257 (58.4) | 111 (62.4) | 93 (53.1) | ||
Lymphadectomy | 0.005 | 0.006 | ||||
< D2 | 136 (73.1) | 293 (66.6) | 130 (73.0) | 103 (58.9) | ||
D2 | 50 (26.9) | 147 (33.4) | 48 (27.0) | 72 (41.1) | ||
Adjuvant chemotherapy | < 0.001 | < 0.001 | ||||
Present | 12 (6.5) | 84 (19.1) | 11 (6.2) | 37 (21.1) | ||
Absent | 174 (93.5) | 356 (80.9) | 167 (93.8) | 138 (78.9) | ||
Death from another disease | < 0.001 | 0.022 | ||||
Present | 33 (17.7) | 37 (8.4) | 31 (17.4) | 16 (9.1) | ||
Absent | 153 (82.3) | 403 (91.6) | 147 (82.6) | 159 (90.9) | ||
Death from primary disease | 0.189 | 0.342 | ||||
Present | 23 (12.4) | 39 (8.9) | 23 (12.9) | 17 (9.7) | ||
Absent | 163 (87.6) | 401 (91.1) | 155 (87.1) | 158 (90.3) | ||
CAR | 0.127 ± 0.342 | 0.066 ± 0.176 | < 0.001 | 0.121 ± 0.340 | 0.066 ± 0.164 | 0.005 |
NLR | 2.797 ± 1.677 | 2.464 ± 1.597 | 0.002 | 2.778 ± 1.647 | 2.366 ± 1.159 | 0.013 |
PLR | 167.1 ± 87.7 | 160.3 ± 85.3 | 0.327 | 168.2 ± 87.9 | 152.4 ± 66.5 | 0.114 |
PNI | 46.4 ± 5.8 | 50.4 ± 5.6 | < 0.001 | 46.5 ± 5.8 | 50.1 ± 5.1 | < 0.001 |
Postoperative long-term outcomes
Patient characteristics in stage III disease
EP group(n = 23) | NEP group(n = 25) | p value | |
---|---|---|---|
Age (years) | 80.5 ± 4.9 | 62.2 ± 8.92 | < 0.001 |
Sex | 0.075 | ||
Male | 21 (91.3) | 17 (68.0) | |
Female | 2 (8.7) | 8 (32.0) | |
CCI | 0.067 | ||
Low | 6 (26.1) | 13 (52.0) | |
Moderate/severe | 17 (73.9) | 12 (48.0) | |
mFI | 0.087 ± 0.068 | 0.051 ± 0.058 | 0.068 |
Tumor size (mm) | 64.1 ± 27.5 | 69.9 ± 31.2 | 0.174 |
Depth of tumor invasion | 0.548 | ||
T1 | 0 | 0 | |
T2 | 2 (8.7) | 2 (8.0) | |
T3 | 10 (43.5) | 14 (56.0) | |
T4 | 11 (47.8) | 9 (36.0) | |
Lymph node metastasis | 0.845 | ||
N0 | 0 | 0 | |
N1 | 2 (8.7) | 3 (12.0) | |
N2 | 11 (47.8) | 9 (36.0) | |
N3 | 10 (43.5) | 13 (52.0) | |
Histologic type | 1.000 | ||
Differentiated | 8 (34.8) | 8 (32.0) | |
Undifferenciated | 15 (65.2) | 17 (68.0) | |
Lymphatic invasion | 0.214 | ||
ly0 | 0 | 0 | |
ly1 | 4 (17.4) | 3 (12.0) | |
ly2 | 8 (34.8) | 15 (60.0) | |
ly3 | 11 (47.8) | 7 (28.0) | |
Venous invasion | 0.907 | ||
v0 | 2 (8.7) | 3 (12.0) | |
v1 | 9 (39.1) | 10 (40.0) | |
v2 | 9 (39.1) | 10 (40.0) | |
v3 | 3 (13.1) | 2 (8.0) |
EP group (n = 23) | NEP group (n = 25) | p value | |
---|---|---|---|
Type of gastrectomy | 0.246 | ||
Distal | 11 (47.8) | 12 (48.0) | |
Total | 10 (43.5) | 13 (52.0) | |
Proximal | 2 (8.7) | 0 | |
Approach | |||
Laparoscopic | 5 (21.7) | 6 (24.0) | |
Open | 18 (78.3) | 19 (76.0) | |
Lymphadectomy | |||
< D2 | 13 (56.5) | 3 (12.0) | |
D2 | 10 (43.5) | 22 (88.0) | |
The numbers of analyzed lymph nodes | 41.1 ± 22.7 | 55.8 ± 22.3 | |
The numbers of positive lymph nodes | 9.74 ± 9.22 | 13.0 ± 17.6 | |
Adjuvant chemotherapy | |||
Present | 7 (30.4) | 20 (80.0) | |
Absent | 16 (69.6) | 5 (20.0) | |
Postoperative complication (CD≥2) | |||
Present | 8 (34.8) | 6 (24.0) | |
Absent | 15 (65.2) | 19 (76.0) | |
Postoperative complication (CD≥3) | |||
Present | 5 (21.7) | 5 (20.0) | |
Absent | 18 (78.3) | 20 (80.0) | |
Death from another disease | |||
Present | 4 (17.4) | 5 (20.0) | |
Absent | 19 (82.6) | 20 (80.0) | |
Death from primary disease | 0.043 | ||
Present | 15 (65.2) | 9 (36.0) | |
Absent | 8 (34.8) | 16 (64.0) |
Systemic inflammatory response in patients with Stage III
EP group (n = 23) | NEP group (n = 25) | P-value | |
---|---|---|---|
WBC | 6796 ± 2069 | 6564 ± 2098 | 0.505 |
CRP | 0.75 ± 1.51 | 0.43 ± 0.65 | 0.055 |
Albumin | 3.73 ± 0.49 | 3.96 ± 0.44 | 0.036 |
PC | 23.1 ± 7.2 | 26.3 ± 7.8 | 0.053 |
CAR | 0.274 ± 0.683 | 0.115 ± 0.187 | 0.046 |
NLR | 3.412 ± 2.074 | 2.902 ± 1.440 | 0.760 |
PLR | 161.9 ± 64.9 | 181.9 ± 90.7 | 0.124 |
PNI | 44.8 ± 5.5 | 48.0 ± 5.4 | 0.045 |
Univariate and multivariate analyses of patients with stage III disease
Univariate analysis | Mutivariate analysis | |||||
---|---|---|---|---|---|---|
Hazard ratio | 95% CI | P value | Hazard ratio | 95% CI | P value | |
Age (≧75vs < 75) | 3.200 | 1.377–7.437 | 0.007 | 1.754 | 0.670–4.594 | 0.252 |
Gender (Female vs Male) | 0.728 | 0.268–1.978 | 0.534 | |||
mFI (≧0.91 vs < 0.91) | 1.296 | 0.573–2.930 | 0.534 | |||
CCI (Moderate/severe vs Low) | 1.017 | 0.453–2.282 | 0.967 | |||
Lymphatic invasion (3 vs 0,1,2) | 3.608 | 1.584–8.214 | 0.002 | 4.356 | 1.695–11.196 | 0.002 |
Venous invasion (2,3 vs 0,1) | 1.241 | 0.555–2.773 | 0.599 | |||
pT(4 vs 1,2,3) | 2.229 | 0.992–5.010 | 0.052 | |||
pN (2,3 vs 0,1) | 1.683 | 0.741–3.820 | 0.213 | |||
The number of positive lymph node (≥5 vs < 5) | 3.517 | 1.045–11.832 | 0.042 | 2.429 | 0.688–8.567 | 0.168 |
Histologic type (Differenciated vs Undifferenciated | 0.448 | 0.177–1.134 | 0.090 | |||
Approach (Laparo vs Open) | 1.513 | 0.625–3.662 | 0.359 | |||
Type of gastrectomy (TG vs DG/PG) | 1.525 | 0.674–3.450 | 0.311 | |||
Lymphadectomy (≥D2 vs < D2) | 0.501 | 0.221–1.136 | 0.098 | |||
Adjuvant chemotherapy (Present vs Absent) | 0.469 | 0.211–0.963 | 0.049 | 0.682 | 0.271–1.512 | 0.402 |
Postoperative complication (CD3 ≥vs < 3) | 1.984 | 0.589–6.689 | 0.269 | |||
CAR (≥0.064 vs < 0.064) | 0.577 | 0.229–1.458 | 0.245 | |||
NLR (≥2.273 vs < 2.273) | 1.186 | 0.526–2.675 | 0.681 | |||
PNI (≥49.8 vs < 49.8) | 2.760 | 1.217–8.522 | 0.046 | 3.321 | 1.116–10.856 | 0.047 |
Site of recurrence in patients with stage III disease
EP group (n = 23) | NEP group (n = 25) | P value | |
---|---|---|---|
Peritoneal metastasis | 0.703 | ||
Present | 3 (13.0) | 5 (20.0) | |
Absent | 20 (87.0) | 20 (80.0) | |
Hematogenous metastasis | 0.020 | ||
Present | 7 (30.4) | 1 (4.0) | |
Absent | 16 (69.6) | 24 (96.0) | |
Lymph node metastasis | 1.000 | ||
Present | 5 (21.7) | 5 (20.0) | |
Absent | 18 (78.3) | 20 (80.0) | |
Local recurrence | 0.479 | ||
Present | 1 (4.3) | 0 (0) | |
Absent | 22 (95.7) | 25 (100) |
Hematogenous metastasis | p value | ||
---|---|---|---|
Present (n = 8) | Absent (n = 40) | ||
Depth of tumor invasion | 0.600 | ||
T2/3 | 4 (50.0) | 24 (60.0) | |
T4 | 4 (50.0) | 16 (40.0) | |
Lymph node metastasis | 0.897 | ||
N1/2 | 4 (50.0) | 21 (52.5) | |
N3 | 4 (50.0) | 19 (47.5) | |
Histologic type | 0.273 | ||
Differentiated | 4 (50.0) | 12 (30.0) | |
Undifferenciated | 4 (50.0) | 28 (70.0) | |
Lymphatic invasion | 1.000 | ||
ly0/1/2 | 5 (62.5) | 25 (62.5) | |
ly3 | 3 (37.5) | 15 (37.5) | |
Venous invasion | 0.439 | ||
v0/1 | 3 (37.5) | 21 (52.5) | |
v2/3 | 5 (62.5) | 19 (47.5) | |
Lymphadectomy | 0.055 | ||
< D2 | 5 (62.5) | 11 (27.5) | |
D2 | 3 (37.5) | 29 (72.5) | |
Adjuvant chemotherapy | 0.242 | ||
Present | 3 (37.5) | 24 (60.0) | |
Absent | 5 (62.5) | 16 (40.0) |