Background
Methods
Patients
N = 366 | |
---|---|
Age | |
<30/31–40/41–50/51–60 | 1/7/11/61 |
61–70/71–80/81–90/91< | 118/120/44/4 |
Sex (male; female) | 267/99 |
ASA-PS 1/2/3 | 210/121/35 |
CCI 2/3/4/5 | 204/96/37/29 |
CCIa 0/1/2/3/4/5 | 183/80/52/26/15/10 |
Surgery | |
DG/TG/LADG/cardiectomy/LR | 134/86/105/28/13 |
Combined resection | |
Yes | 81 |
No | 285 |
Pathological stage I/II/III | 236/70/60 |
Postoperative complications | |
C. D. grade I/II/III/IV/V | 11/17/16/2/3 |
Curability A/B/C | 362/4/0 |
Onodera PNI <40/≥40 | 47/319 |
Chemotherapy | |
Present | 91 |
Absent | 275 |
Pathological diagnosis
Inflammatory responses and nutrition
Surgery
Postoperative complications
Follow-up
Chemotherapy
Statistical analyses
Results
Group A (n = 117) | Group B (n = 249) | |
---|---|---|
Incisional SSI | 5 (4.3%) | 4 (1.6%) |
Pancreatic fistula | 3 (2.6%) | 6 (2.4%) |
Anastomotic leakage | 3 (2.6%) | 10 (4.0%) |
Pneumonia | 2 (1.7%) | 2 (0.8%) |
AKI | 2 (1.7%) | 0 (0%) |
Anastomotic ulcer | 1 (0.8%) | 1 (0.4%) |
Anastomotic edema | 1 (0.8%) | 0 (0%) |
Pulmonary embolism | 1 (0.8%) | 0 (0%) |
Sigmoid colon volvulus | 1 (0.8%) | 0 (0%) |
Sudden death | 1 (0.8%) | 0 (0%) |
CRBSI | 0 (0%) | 2 (0.8%) |
Postoperative bleeding | 0 (0%) | 2 (0.8%) |
Chylous ascites | 0 (0%) | 2 (0.8%) |
Overall survival | Disease-specific survival | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Univariate analysis | Multivariate analysis | Univariate analysis | Multivariate analysis | ||||||||
n
| MST (months) | Hazard ratio (95% CI) |
P value | Hazard ratio (95% CI) |
P value | MST (months) | Hazard ratio (95% CI) |
P value | Hazard ratio (95% CI) |
P value | |
Sex | – | – | – | 0.229 | – | – | – | – | 0.890 | – | – |
Males | 82 | 74.0 | 1.16 (0.63–2.24) | – | – | – | – | 1.00 | – | – | – |
Females | 35 | 70.8 | 1.00 | – | – | – | – | 1.18 (0.44–3.68) | – | – | – |
ASA-PS | – | – | – | 0.041* | – | – | – | – | 0.014* | – | 0.002* |
1 | 30 | – | 1.00 | – | – | – | – | 1.00 | – | 1.00 | – |
2 | 65 | 80.2 | 1.29 (0.64–2.71) | – | – | – | – | 1.12 (0.33–4.31) | – | 0.14 (0.01–1.53) | – |
3 | 22 | 34.3 | 2.88 (1.30–6.47) | – | – | – | – | 3.58 (1.06–13.87) | – | 9.11 (1.20–103.77) | – |
Surgery | – | – | – | 0.040* | – | 0.636 | – | – | 0.036* | – | 0.476 |
DG | 50 | 70.8 | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
TG | 23 | 32.4 | 1.54 (0.73–3.07) | – | 1.35 (0.52–3.32) | – | – | 1.72 (0.51–5.18) | – | 2.48 (0.20–26.78) | – |
LADG | 25 | – | 0.36 (0.08–1.07) | – | 0.68 (0.14–2.43) | – | – | 1.18e−9 (0–0.65) | – | 1.33e−9 (0–28.12) | – |
Cardiectomy | 11 | 33.0 | 2.54 (1.09–5.44) | – | 1.75 (0.62–4.62) | – | 50.6 | 3.46 (1.03–10.56) | – | 0.23 (0.02–2.35) | – |
LR | 8 | – | 0.87 (0.13–3.00) | – | 0.71 (0.10–3.20) | – | – | 1.16e−9 (5.39e−16–7.35e−130) | – | 5.54e−10 (0–24.97) | – |
Histology | – | – | – | 0.420 | – | – | – | – | 0.134 | – | – |
Intestinal | 76 | 74.0 | 1.00 | – | – | – | – | 1.00 | – | – | – |
Diffuse | 41 | 51.6 | 1.30 (0.72–2.30) | – | – | – | – | 2.24 (0.88–5.87) | – | – | – |
Tumor size | – | – | – | 0.018* | – | 0.793 | – | 0.003* | – | 0.358 | |
<5 cm | 68 | 80.2 | 1.00 | – | 1.12 (0.46–2.81) | – | – | 1.00 | – | 2.69 (0.31–23.75) | – |
≥5 cm | 49 | 50.5 | 1.93 (1.09–3.47) | – | 1.00 | – | – | 3.68 (1.38–11.49) | – | 1.00 | – |
Depth of invasion (T) | – | – | – | <0.001* | – | 0.317 | – | – | <0.001* | – | 0.005* |
T1 | 57 | 80.2 | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
T2 | 18 | 88.8 | 0.54 (0.15–1.47) | – | 0.30 (0.06–1.09) | – | – | 1.26e−8 (0–15.07) | – | 2.86e−10 (0–2.92) | – |
T3 | 20 | 38.4 | 2.16 (1.01–4.48) | – | 0.65 (0.18–2.15) | – | – | 20.02 (3.55–374.36) | – | 15.44 (1.16–642.77) | – |
T4 | 22 | 25.2 | 2.50 (1.22–5.03) | – | 0.87 (0.27–2.61) | – | 50.5 | 33.63 (6.43–617.14) | – | 10.86 (0.65–432.23) | – |
Lymphatic invasion (ly) | – | – | – | 0.013* | – | 0.328 | – | – | 0.013* | – | 0.578 |
ly0, ly1 | 73 | 88.8 | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
ly2, ly3 | 43 | 41.3 | 2.29 (1.29–4.08) | – | 1.49 (0.66–3.34) | – | – | 3.90 (1.51–11.21) | – | 1.79 (0.22–14.91) | – |
Venous invasion (v) | – | – | – | 0.001* | – | 0.944 | – | – | <0.001* | – | 0.013* |
v0, v1 | 77 | 80.2 | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
v2, v3 | 40 | 37.2 | 2.18 (1.22–3.87) | – | 1.02 (0.44–2.26) | – | 50.6 | 11.97 (3.94–51.74) | – | 9.38 (6.56–82.05) | – |
Lymph node metastasis (N) | – | – | – | <0.001* | – | 0.178 | – | – | <0.001* | – | 0.010* |
N0 | 73 | 88.8 | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
N1 | 20 | 41.3 | 2.91 (1.29–6.58) | – | 2.41 (0.84–6.84) | – | 51.6 | 6.30 (1.89–24.18) | – | 5.40 (0.67–55.78) | – |
N2 | 13 | – | 3.19 (1.25–7.71) | – | 0.92 (0.18–3.80) | – | – | 1.65e−8 (0–3.37) | – | 8.07e−11 (0–1.20) | – |
N3 | 11 | 17.9 | 8.82 (4.21–19.22) | – | 3.76 (0.86–15.50) | – | 25.2 | 28.24 (7.99–115.80) | – | 6.70 (0.34–219.73) | – |
Clavien–Dindo | – | – | – | <0.001* | – | <0.001* | – | – | <0.001* | – | <0.001* |
0 | 97 | 70.8 | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
I | 5 | – | 0.86 (0.14–2.84) | – | 0.52 (0.07–2.21) | – | – | 1.24 (0.06–6.35) | – | 0.24 (0.01–3.42) | – |
II | 6 | 88.8 | 0.28 (0.01–1.32) | – | 0.82 (0.04–5.79) | – | – | 6.15e−9 (0–2.07) | – | 12.78 (0–5.28e298) | – |
III | 5 | 37.2 | 1.81 (0.43–5.05) | – | 2.33 (0.44–10.33) | – | – | 1.92 (0.10–9.83) | – | 1.09 (0.01–104.71) | – |
IV | 1 | 7.7 | 27.25 (1.39–184.77) | – | 7.69 (0.35–67.41) | – | 7.7 | 8.73e16 (18.30–1.89e109) | – | 8.31e18 (15.71-NC) | – |
V | 3 | 1.1 | 5.21e10 (87.65–1.64e31) | – | 1.08e11 (57.71–9.25e141) | – | 1.1 | 7.72e31 (255.05-NC) | – | 5.71e33 (296.06–3.28e306) | – |
Onodera PNI | – | – | – | <0.001* | – | 0.056 | – | – | 0.010* | – | 0.698 |
<40 | 29 | 33.0 | 2.65 (1.47–4.69) | – | 2.03 (0.97–4.17) | – | – | 2.35 (0.86–5.98) | – | 1.42 (0.23–9.56) | – |
≥40 | 88 | 80.2 | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
Modified GPS | – | – | – | 0.375 | – | – | – | – | 0.574 | – | – |
0 | 96 | 70.8 | 1.00 | – | – | – | – | 1.00 | – | – | – |
1 | 7 | – | 0.82 (0.13–2.71) | – | – | – | – | 1.24 (0.06–6.21) | – | – | – |
2 | 14 | 34.3 | 1.54 (0.66–3.15) | – | – | – | – | 1.59 (0.36–4.89) | – | – | – |
Chemotherapy | – | – | – | 0.562 | – | – | – | – | 0.252 | – | – |
Yes | 24 | 50.6 | 1.00 | – | – | – | – | 1.00 | – | – | – |
No | 93 | 74.0 | 1.42 (0.74–2.60) | – | – | – | – | 2.77 (1.05–7.03) | – | – | – |
Overall survival | Disease-specific survival | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Univariate analysis | Multivariate analysis | Univariate analysis | Multivariate analysis | ||||||||
n
| MST (months) | Hazard ratio (95% CI) |
p value | Hazard ratio (95% CI) |
p value | MST (months) | Hazard ratio (95% CI) |
p value | Hazard ratio (95% CI) |
p value | |
Sex | – | – | – | 0.204 | – | – | – | – | 0.246 | – | – |
Males | 185 | – | 1.96 (0.75–6.72) | – | – | – | – | 2.35 (0.65–15.04) | – | – | – |
Females | 64 | – | 1.00 | – | – | – | – | 1.00 | – | – | – |
ASA-PS | – | – | – | <0.001* | – | 0.274 | – | – | 0.777 | – | – |
1 | 180 | – | 1.00 | – | 1.00 | – | – | 1.00 | – | – | – |
2 | 56 | – | 2.37 (0.90–5.69) | – | 2.17 (0.09–6.14) | – | – | 0.74 (0.11–2.72) | – | – | – |
3 | 13 | 76.4 | 6.62 (1.86–18.61) | – | 3.23 (0.50–16.85) | – | – | 1.74 (0.09–8.97) | – | – | – |
Surgery | – | – | – | 0.023* | – | 0.932 | – | – | 0.023* | – | 0.935 |
DG | 84 | – | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
TG | 63 | 96.9 | 1.29 (0.55–2.96)) | – | 1.20 (0.44–3.28) | – | – | 0.76 (0.24–2.15) | – | 1.95 (0.3–11.86) | – |
LADG | 80 | – | 0.17 (0.03–0.61) | – | 0.69 (0.09–3.72) | – | – | 2.67e−10 (0–0.23) | – | 1.75e−8 (0–83.40) | – |
Cardiectomy | 15 | – | 0.33 (0.01–1.66) | – | 1.19 (0.06–9.75) | – | – | 2.67e−10 (0–1.00) | – | (0-NC) | – |
LR | 7 | – | 3.17e−9 (1.12e−55–2.10) | – | 7.82e−9 (4.43e−54–13.53) | – | – | 2.67e−10 (9.69e−301–2.97) | – | 0.20 (4.22e−59-NC) | – |
Histology | – | – | – | 0.205 | – | – | – | – | 0.066 | – | – |
Intestinal | 110 | – | 1.00 | – | – | – | – | 1.00 | – | – | – |
Diffuse | 139 | – | 1.70 (0.76–4.15) | – | – | – | – | 3.08 (0.98–13.52) | – | – | – |
Tumor size (cm) | – | – | – | 0.002* | – | 0.637 | – | – | <0.001* | – | 0.810 |
<5 cm | 172 | – | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
≥5 cm | 77 | – | 3.19 (1.47–7.03) | – | 1.32 (0.41–4.11) | – | – | 10.63 (3.37–46.69) | – | 0.76 (0.08–8.99) | – |
Depth of invasion (T) | – | – | – | <0.001* | – | 0.172 | – | – | <0.001* | – | 0.013* |
T1 | 154 | – | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
T2 | 33 | – | 2.29 (0.48–8.69) | – | 0.64 (0.08–4.25) | – | – | 1.75e9 (0.80–9.06e145) | – | 1.22e9 (0.01–2.39e139) | – |
T3 | 23 | – | 4.04 (0.85–15.42) | – | 1.27 (0.18–8.21) | – | – | 2.70e9 (1.24–1.54e260) | – | 5.48e9 (0.03–3.32e96) | – |
T4 | 39 | – | 13.16 (5.23–37.50) | – | 3.02 (0.65–17.33) | – | – | 2.41e10 (31.03–1.23e144) | – | 6.14e10 (0.89–1.81e81) | – |
Lymphatic invasion (ly) | – | – | – | 0.045* | – | 0.189 | – | – | 0.003* | – | 0.009* |
ly0, ly1 | 192 | – | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
ly2, ly3 | 57 | – | 2.94 (1.31–6.41) | – | 0.37 (0.07–1.60) | – | – | 4.20 (1.50–12.00) | – | 0.05 (0.01–0.51) | – |
Venous invasion (v) | – | – | – | 0.005* | – | 0.815 | – | – | 0.029* | – | 0.271 |
v0, v1 | 198 | – | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
v2, v3 | 51 | – | 2.95 (1.29–6.43) | – | 0.87 (0.26–2.88) | – | – | 2.99 (1.00–8.29) | – | 0.40 (0.07–2.02) | – |
Lymph node metastasis (N) | – | – | – | <0.001* | – | 0.008* | – | – | <0.001* | – | <0.001* |
N0 | 180 | – | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
N1 | 30 | – | 4.24 (1.42–11.76) | – | 1.96 (0.41–8.34) | – | – | 24.94 (3.69–487.50) | – | 27.56 (1.97–1080.37) | – |
N2 | 20 | – | 2.66 (0.41–10.38) | – | 0.94 (0.11–5.91) | – | – | 21.84 (2.09–470.13) | – | 13.89 (0.94–453.66) | – |
N3 | 19 | 66.1 | 14.93 (5.71–39.31) | – | 10.55 (1.99-73.65) | – | 66.1 | 97.33 (17.79–807.31) | – | 208.72 (10.54–14986.60) | – |
Clavien–Dindo | – | – | – | 0.654 | – | – | – | – | 0.235 | – | – |
0 | 220 | – | 1.00 | – | – | – | – | 1.00 | – | – | – |
I | 6 | – | 2.09 (0.12–10.05) | – | – | – | – | 3.65 (0.20–18.82) | – | – | – |
II | 11 | – | 2.09 (0.33–7.15) | – | – | – | – | 1.91 (0.10–9.82) | – | – | – |
III | 11 | – | 2.18 (0.35–7.46) | – | – | – | – | 4.27 (0.66–15.93) | – | – | – |
IV | 1 | – | 1.17e−7 (0–86.79) | – | – | – | – | 2.27e−7 (0–143.14) | – | – | – |
Onodera PNI | – | – | – | <0.001* | – | 0.091 | – | – | 0.008* | – | 0.261 |
<40 | 18 | 86.8 | 8.25 (3.17–19.21) | – | 4.92 (0.76–25.22) | – | – | 4.75 (1.07–15.12) | – | 6.47 (0.22–158.87) | – |
≥40 | 231 | – | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
Modified GPS | – | – | – | <0.001* | – | 0.328 | – | – | <0.001* | – | 0.865 |
0 | 227 | – | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
1 | 10 | – | 2.98 (0.47–10.34) | – | 3.61 (0.49–16.92) | – | – | 2.44 (0.13–12.55) | – | 1.31 (0.05-14.33) | – |
2 | 12 | 36.3 | 15.12 (5.34–37.46) | – | 2.20 (0.25–14.83) | – | – | 10.52 (2.34–34.66) | – | 2.32 (0.04–35.52) | – |
Chemotherapy | – | – | <0.001* | – | 0.196 | – | – | <0.001* | – | 0.038* | |
Yes | 67 | – | 1.00 | – | 1.00 | – | – | 1.00 | – | 1.00 | – |
No | 182 | – | 5.87 (2.68–13.49) | – | 2.84 (0.57–13.55) | – | – | 45.67 (9.16–827.80) | – | 43.58 (1.20-3226.69) | – |
Overall survival | Disease-specific survival | ||
---|---|---|---|
Univariate analysis | Multivariate analysis | Univariate analysis | Multivariate analysis |
ASA-PS | Postoperative complications | ASA-PS | ASA-PS |
Surgery | Surgery | T | |
Tumor size | Tumor size | v | |
T | T | N | |
ly | ly | Postoperative complications | |
v | v | ||
N | N | ||
Postoperative complications | Postoperative complications | ||
Onodera PNI | Onodera PNI |
Overall survival | Disease-specific survival | ||
---|---|---|---|
Univariate analysis | Multivariate analysis | Univariate analysis | Multivariate analysis |
ASA-PS | N | Surgery | T |
Surgery | Tumor size | ly | |
Tumor size | T | N | |
T | ly | Chemotherapy | |
ly | v | ||
v | N | ||
N | Onodera PNI | ||
Onodera PNI | Modified GPS | ||
Modified GPS | Postoperative chemotherapy | ||
Postoperative chemotherapy |