Background
Methods
Patients
Baseline and preoperative evaluations
Preoperative adverse events evaluation
Postoperative complications evaluation
Statistical analyses
Results
Clinical-pathological characteristics
CD0 group (n = 61) | CD1/2 group (n = 44) | CD3/4 group (n = 10) | Total (n = 115) |
P Value | |
---|---|---|---|---|---|
Ageb (year) | 56.0 (27.0–78.0) | 56.0 (26.0–76.0) | 58.5 (41.0–75.0) | 56.0 (26.0–78.0) | 0.467 |
Gender | 0.452 | ||||
Male | 36 (59.0) | 31 (70.5) | 7 (70.0) | 74 (64.3) | |
Female | 25 (41.0) | 13 (29.5) | 3 (30.0) | 41 (35.7) | |
BMI before surgeryb (kg/m2) | 21.9 (17.3–30.7) | 23.1 (17.1–32.4) | 21.1 (16.9–29.0) | 22.3 (16.9–32.4) | 0.272 |
Tumor location | 0.109 | ||||
Proximal one-third | 12 (19.7) | 21 (47.7) | 2 (20.0) | 35 (30.4) | |
Middle one-third | 18 (29.5) | 8 (18.2) | 3 (30.0) | 29 (25.2) | |
Distal one-third | 23 (37.7) | 12 (27.3) | 4 (40.0) | 39 (33.9) | |
Whole | 8 (13.1) | 3 (6.8) | 1 (10.0) | 12 (10.4) | |
Preoperative treatment | 0.881 | ||||
PCT | 50 (82.0) | 34 (77.3) | 8 (80.0) | 92 (80.0) | |
PCRT | 11 (18.0) | 10 (22.7) | 2 (20.0) | 23 (20.0) | |
Cyclesb
| 5.0 (2.0–20.0) | 7.0 (2.0–19.0) | 7.5 (2.0–21.0) | 5.0 (2.0–21.0) | 0.082 |
Durationb (month) | 3.1 (1.2–15.6) | 4.5 (1.2–18.0) | 5.4 (1.2–15.2) | 3.6 (1.2–18.0) | 0.061 |
Interval timeb (month) | 1.1 (0.4–5.7) | 1.0 (0.4–4.5) | 1.2 (0.5–2.4) | 1.1 (0.4–5.7) | 0.167 |
Chemotherapy regimen | 0.922 | ||||
Platinum-containing | 38 (62.3) | 25 (56.8) | 8 (80.0) | 71 (61.7) | |
Taxane-containing | 7 (11.5) | 6 (13.6) | 1 (10.0) | 14 (12.2) | |
Containing both platinum and taxane | 14 (23.0) | 11 (25.0) | 1 (10.0) | 26 (22.6) | |
Others | 2 (3.3) | 2 (4.5) | 0 (0.0) | 4 (3.5) | |
Postoperative hospital stayb (day) | 8.0 (5.0–12.0) | 10.0 (7.0–27.0) | 19.0 (11.0–29.0) | 9.0 (5.0–29.0) | <0.001 |
CD0 group (n = 61) | CD1/2 group (n = 44) | CD3/4 group (n = 10) | Total (n = 115) |
P Value | |
---|---|---|---|---|---|
Surgical type | 0.672 | ||||
Open | 55 (90.2) | 42 (95.5) | 9 (90.0) | 106 (92.2) | |
MIS | 6 (9.8) | 2 (4.5) | 1 (10.0) | 9 (7.8) | |
Gastrectomy | 0.219 | ||||
Subtotal | 31 (50.8) | 15 (34.1) | 5 (50.0) | 51 (44.3) | |
Total | 30 (49.2) | 29 (65.9) | 5 (50.0) | 64 (55.7) | |
Surgical radicality | 0.802 | ||||
Radical | 37 (60.7) | 29 (65.9) | 7 (70.0) | 73 (63.5) | |
Palliative | 24 (39.3) | 15 (34.1) | 3 (30.0) | 42 (36.5) | |
Lymphadenectomy | 0.504 | ||||
D2 | 47 (77.0) | 31 (70.5) | 8 (80.0) | 86 (74.8) | |
D1 plus | 13 (21.3) | 10 (22.7) | 1 (10.0) | 24 (20.9) | |
D1 | 1 (1.6) | 3 (6.8) | 1 (10.0) | 5 (4.3) | |
Combined resection | 0.592 | ||||
Yes | 12 (19.7) | 7 (15.9) | 3 (30.0) | 22 (19.1) | |
No | 49 (80.3) | 37 (84.1) | 7 (70.0) | 93 (80.9) | |
EBLb (mL) | 95 (28–300) | 126 (30–609) | 269 (50–640) | 100 (28–640) | 0.017 |
Transfusion | <0.001 | ||||
Yes | 0 (0.0) | 17 (38.6) | 1 (10.0) | 18 (15.7) | |
No | 61 (100.0) | 27 (61.4) | 9 (90.0) | 97 (84.3) | |
Borrmann type | 0.524 | ||||
I | 6 (9.8) | 2 (4.5) | 2 (20.0) | 10 (8.7) | |
II | 12 (19.7) | 10 (22.7) | 1 (10.0) | 23 (20.0) | |
III | 32 (52.5) | 20 (45.5) | 6 (60.0) | 58 (50.4) | |
IV | 11 (18.0) | 12 (27.3) | 1 (10.0) | 24 (20.9) | |
Lauren type | 0.569 | ||||
Intestinal | 30 (49.2) | 23 (52.3) | 6 (60.0) | 59 (51.3) | |
Diffuse | 26 (42.6) | 18 (40.9) | 2 (20.0) | 46 (40.0) | |
Mixed | 5 (8.2) | 3 (6.8) | 2 (20.0) | 10 (8.7) | |
TNM Stage | 0.846 | ||||
yp 0 | 4 (6.6) | 1 (2.3) | 1 (10.0) | 6 (5.2) | |
yp Ia-Ib | 14 (23.0) | 7 (15.9) | 1 (10.0) | 22 (19.1) | |
yp IIa-IIb | 6 (9.8) | 6 (13.6) | 2 (20.0) | 14 (12.2) | |
yp IIIa-IIIc | 15 (24.6) | 15 (34.1) | 3 (30.0) | 33 (28.7) | |
yp IV | 22 (36.1) | 15 (34.1) | 3 (30.0) | 40 (34.8) |
Incidence and type of preoperative adverse events
CD0 group (n = 61) | CD1/2 group (n = 44) | CD3/4 group (n = 10) | Total (n = 115) |
P Value | |
---|---|---|---|---|---|
Anemia | 0.099 | ||||
Grade 0 | 6 (5.2) | 6 (5.2) | 0 (0.0) | 12 (10.4) | |
Grade 1/2 | 48 (41.7) | 27 (23.5) | 6 (5.2) | 81 (70.4) | |
Grade 3/4 | 7 (6.1) | 11 (9.6) | 4 (3.5) | 22 (19.1) | |
Leukopenia | 0.326 | ||||
Grade 0 | 24 (20.9) | 9 (7.8) | 4 (3.5) | 37 (32.2) | |
Grade 1/2 | 21 (18.3) | 21 (18.3) | 3 (2.6) | 45 (39.1) | |
Grade 3/4 | 16 (13.9) | 14 (12.2) | 3 (2.6) | 33 (28.7) | |
Neutropenia | 0.244 | ||||
Grade 0 | 16 (13.9) | 4 (3.5) | 3 (2.6) | 23 (20.0) | |
Grade 1/2 | 19 (16.5) | 16 (13.9) | 3 (2.6) | 38 (33.0) | |
Grade 3/4 | 26 (22.6) | 24 (20.9) | 4 (3.5) | 54 (47.0) | |
Febrile neutropenia | 0.829 | ||||
Grade 0 | 49 (42.6) | 35 (30.4) | 9 (7.8) | 93 (80.9) | |
Grade 3/4 | 12 (10.4) | 9 (7.8) | 1 (0.9) | 22 (19.1) | |
Lymphocytopenia | 0.748 | ||||
Grade 0 | 10 (8.7) | 9 (7.8) | 2 (1.7) | 21 (18.3) | |
Grade 1/2 | 41 (35.7) | 29 (25.2) | 5 (4.3) | 75 (65.2) | |
Grade 3/4 | 10 (8.7) | 6 (5.2) | 3 (2.6) | 19 (16.5) | |
Thrombocytopenia | 0.798 | ||||
Grade 0 | 39 (33.9) | 26 (22.6) | 8 (7.0) | 73 (63.5) | |
Grade 1/2 | 19 (16.5) | 16 (13.9) | 2 (1.7) | 37 (32.2) | |
Grade 3/4 | 3 (2.6) | 2 (1.7) | 0 (0.0) | 5 (4.3) | |
Increased ALT/AST | 0.718 | ||||
Grade 0 | 34 (29.6) | 28 (24.3) | 6 (5.2) | 68 (59.1) | |
Grade 1/2 | 27 (23.5) | 16 (13.9) | 4 (3.5) | 47 (40.9) | |
Increased Scr | 1.000 | ||||
Grade 0 | 58 (50.4) | 41 (35.7) | 9 (7.8) | 108 (93.9) | |
Grade 1/2 | 3 (2.6) | 3 (2.6) | 1 (0.9) | 7 (6.1) | |
Total AEs | 0.138 | ||||
Grade 0 | 0 (0.0) | 1 (0.9) | 0 (0.0) | 1 (0.9) | |
Grade 1/2 | 29 (25.2) | 11 (9.6) | 3 (2.6) | 43 (37.4) | |
Grade 3/4 | 32 (27.8) | 32 (27.8) | 7 (6.1) | 71 (61.7) |
CD0 group (n = 61) | CD1/2 group (n = 44) | CD3/4 group (n = 10) | Total (n = 115) |
P Value | |
---|---|---|---|---|---|
Anemia | 0.724 | ||||
Grade 0 | 23 (20.0) | 13 (11.3) | 2 (1.7) | 38 (33.0) | |
Grade 1/2 | 36 (31.3) | 30 (26.1) | 8 (7.0) | 74 (64.3) | |
Grade 3/4 | 2 (1.7) | 1 (0.9) | 0 (0.0) | 3 (2.6) | |
Leukopenia | 0.196 | ||||
Grade 0 | 38 (33.0) | 27 (23.5) | 10 (8.7) | 75 (65.2) | |
Grade 1/2 | 19 (16.5) | 15 (13.0) | 0 (0.0) | 34 (29.6) | |
Grade 3/4 | 4 (3.5) | 2 (1.7) | 0 (0.0) | 6 (5.2) | |
Neutropenia | 0.740 | ||||
Grade 0 | 38 (33.0) | 26 (22.6) | 8 (7.0) | 72 (62.6) | |
Grade 1/2 | 16 (13.9) | 12 (10.4) | 2 (1.7) | 30 (26.1) | |
Grade 3/4 | 7 (6.1) | 6 (5.2) | 0 (0.0) | 13 (11.3) | |
Lymphocytopenia | 0.720 | ||||
Grade 0 | 31 (27.0) | 19 (16.5) | 6 (5.2) | 56 (48.7) | |
Grade 1/2 | 27 (23.5) | 24 (20.9) | 4 (3.5) | 55 (47.8) | |
Grade 3/4 | 3 (2.6) | 1 (0.9) | 0 (0.0) | 4 (3.5) | |
Thrombocytopenia | 0.577 | ||||
Grade 0 | 45 (39.1) | 34 (29.6) | 9 (7.8) | 88 (76.5) | |
Grade 1/2 | 16 (13.9) | 10 (8.7) | 1 (0.9) | 27 (23.5) | |
Total AEs | 0.421 | ||||
Grade 0 | 14 (12.2) | 8 (7.0) | 1 (0.9) | 23 (20.0) | |
Grade 1/2 | 36 (31.3) | 28 (24.3) | 9 (7.8) | 73 (63.5) | |
Grade 3/4 | 11 (9.6) | 8 (7.0) | 0 (0.0) | 19 (16.5) |
Incidence and type of postoperative complications
CD1/2 group (n = 44) | CD3/4 group (n = 10) | Totalb (n = 115) | |
---|---|---|---|
Non-surgery-related | |||
Pulmonary-related | 17 (14.8) | 3 (2.6) | 20 (17.4) |
Deep vein thrombus | 1 (0.9) | 0 (0.0) | 1 (0.9) |
Unexplained fever | 7 (6.1) | 0 (0.0) | 7 (6.1) |
Transfusion | 17 (14.8) | 1 (0.9) | 18 (15.7) |
Othersc
| 3 (2.6) | 1 (0.9) | 4 (3.5) |
Surgery-related | |||
Wound discharge/infection | 5 (4.3) | 2 (1.7) | 7 (6.1) |
Intestinal obstruction | 3 (2.6) | 1 (0.9) | 4 (3.5) |
Fluid collection | 9 (7.8) | 1 (0.9) | 10 (8.7) |
Gastrointestinal tract leakage/abscess | 1 (0.9) | 6 (5.2) | 7 (6.1) |
Complication type | |||
Not infection-related | 26 (22.6) | 3 (2.6) | 29 (25.2) |
Infection-related | 12 (10.4) | 7 (6.1) | 19 (16.5) |
Clavien-Dindo grade | |||
Grade 1 | 15 (13.0) | NA | 15 (13.0) |
Grade 2 | 29 (25.2) | NA | 29 (25.2) |
Grade 3 | NA | 8 (7.0) | 8 (7.0) |
Grade 4 | NA | 2 (1.7) | 2 (1.7) |
Correlation analyses of preoperative adverse events and postoperative complications
Differences in laboratory tests, inflammation-based prognostic scores, and nutrition index
CD0 group (n = 61) | CD1/2 group (n = 44) | CD3/4 group (n = 10) |
P Value | |
---|---|---|---|---|
Baseline | ||||
HB (g/L) | 129 (66–155) | 121 (64–170) | 112 (72–159) | 0.284 |
WBC (×109/L) | 5.9 (3.6–13.9) | 6.4 (3.6–14.2) | 8.1 (3.9–10.2) | 0.109 |
NEU (×109/L) | 3.6 (2.2–10.9) | 3.9 (2.0–11.7) | 4.8 (1.4–7.7) | 0.136 |
LYM (×109/L) | 1.7 (0.7–3.1) | 1.8 (0.6–3.0) | 2.0 (1.4–2.4) | 0.238 |
PLT (×109/L) | 298.0 (96.0–639.0) | 295.0 (141.0–599.0) | 301.5 (166.0–438.0) | 0.784 |
ALB (g/L) | 42.0 (35.0–49.0) | 41.0 (28.0–47.0) | 39.0 (25.0–48.0) | 0.631 |
ALT (U/L) | 14.0 (5.0–75.0) | 14.5 (5.0–58.0) | 13.0 (7.0–59.0) | 0.888 |
AST (U/L) | 17.0 (10.0–56.0) | 15.0 (8.0–73.0) | 19.5 (10.0–37.0) | 0.473 |
ALP (U/L) | 56.0 (24.0–109.0) | 59.5 (25.0–123.0) | 71.5 (31.0–99.0) | 0.137 |
Scr (mg/dL) | 0.82 (0.48–1.20) | 0.86 (0.53–1.28) | 0.81 (0.68–1.59) | 0.593 |
aPTT (second) | 29.8 (23.0–37.2) | 29.6 (24.9–38.6) | 28.6 (24.9–33.1) | 0.315 |
PT (second) | 10.9 (9.3–12.8) | 11.0 (9.0–13.1) | 11.1 (9.5–12.7) | 0.765 |
INR | 0.96 (0.82–1.12) | 0.97 (0.79–1.16) | 0.98 (0.84–1.11) | 0.883 |
PNI | 50.2 (40.4–61.8) | 50.6 (34.2–60.0) | 49.7 (33.0–60.2) | 0.954 |
NLR | 2.5 (0.7–6.6) | 2.2 (1.0–9.5) | 2.4 (0.7–7.8) | 0.805 |
PLR | 181.9 (67.6–557.7) | 179.1 (73.8–487.0) | 171.1 (78.3–256.9) | 0.683 |
Preoperative | ||||
HB (g/L) | 116 (86–152) | 115 (76–160) | 117 (91–125) | 0.810 |
WBC (×109/L) | 4.7 (2.3–11.7) | 4.7 (2.7–11.9) | 5.8 (3.0–9.7) | 0.598 |
NEU (×109/L) | 2.7 (0.7–8.8) | 2.6 (1.2–9.1) | 3.0 (1.5–7.8) | 0.755 |
LYM (×109/L) | 1.5 (0.5–3.4) | 1.6 (0.4–2.7) | 1.3 (0.6–2.9) | 0.835 |
PLT (×109/L) | 218.0 (73.0–398.0) | 202.0 (91.0–583.0) | 216.5 (167.0–276.0) | 0.861 |
ALB (g/L) | 40.0 (27.0–48.0) | 39.5 (26.0–52.0) | 39.0 (32.0–41.0) | 0.541 |
ALT (U/L) | 17.0 (6.0–72.0) | 14.0 (6.0–52.0) | 15.5 (11.0–43.0) | 0.431 |
AST (U/L) | 20.0 (12.0–75.0) | 19.0 (11.0–42.0) | 19.0 (12.0–42.0) | 0.671 |
ALP (U/L) | 61.5 (21.0–142.0) | 59.5 (25.0–106.0) | 63.5 (35.0–163.0) | 0.887 |
Scr (mg/dL) | 0.78 (0.43–1.39) | 0.78 (0.38–1.55) | 0.75 (0.63–1.34) | 0.874 |
aPTT (second) | 29.9 (24.2–41.5) | 29.7 (20.7–37.5) | 31.0 (26.1–34.6) | 0.979 |
PT (second) | 10.5 (9.4–13.1) | 10.9 (9.4–13.4) | 10.5 (9.6–11.7) | 0.196 |
INR | 0.93 (0.83–1.15) | 0.97 (0.83–1.18) | 0.94 (0.85–1.01) | 0.147 |
CRPb (mg/L) | 1.1 (0.3–51.1) | 1.3 (0.4–68.6) | 1.8 (0.5–13.9) | 0.502 |
PNI | 46.8 (30.5–59.9) | 46.0 (33.2–62.1) | 45.4 (37.2–54.3) | 0.801 |
NLR | 1.7 (0.6–9.6) | 1.9 (0.6–9.7) | 2.0 (0.8–10.1) | 0.811 |
PLR | 134.6 (38.2–574.1) | 123.4 (44.7–640.7) | 148.3 (66.1–392.1) | 0.714 |
GPSb,c
| 0.804 | |||
Score 0 | 43 (81.1) | 30 (76.9) | 7 (87.5) | |
Score 1 | 8 (15.1) | 6 (15.4) | 0 (0.0) | |
Score 2 | 2 (3.8) | 3 (7.7) | 1 (12.5) | |
PIb,c
| 0.572 | |||
Score 0 | 49 (92.5) | 35 (89.7) | 7 (87.5) | |
Score 1 | 4 (7.5) | 4 (10.3) | 1 (12.5) |