胃癌根治术后并发症发生及长期生存现状：单中心5 111例真实世界研究

Postoperative complications and long-term survival after radical gastrectomy for gastric cancer: a real-world single-center study of 5 111 cases

摘要:

背景与目的 胃癌根治术后并发症仍是影响患者短期康复及长期生存的重要因素，但真实世界中大样本胃癌患者围手术期并发症及预后情况仍缺乏系统研究。本研究基于单中心真实世界数据库，分析胃癌根治术后并发症发生情况、长期生存现状及其相关影响因素。方法 采用回顾性队列研究方法，收集2011年1月─2023年12月湖南省肿瘤医院接受胃癌根治术患者的临床病理资料。术后并发症依据Clavien-Dindo并发症分级标准评估，将Ⅱ级及以上并发症定义为观察终点。采用Logistic回归分析术后并发症发生危险因素；Kaplan-Meier法分析总体生存（OS），Cox回归分析OS独立影响因素。结果 共纳入5 111例患者，其中538例（10.53%）发生Clavien-Dindo并发症分级Ⅱ级及以上并发症，共693例次。最常见并发症为肺部感染（3.1%）、腹腔感染（2.3%）、胸腔积液（1.8%）、腹水（1.0%）及吻合口漏（0.9%）；围手术期死亡30例（0.59%）。多因素Logistic回归分析显示，年龄≥65岁、合并基础疾病、术前白蛋白<35 g/L、手术时间≥240 min、术中出血量≥300 mL、开放手术及全胃切除是术后并发症独立危险因素（均P<0.05）。全组患者5年OS率为62.5%。多因素Cox回归分析显示，年龄≥65岁、低BMI、全胃切除、围手术期输血、术后并发症及晚期pTNM分期均为OS独立危险因素（均P<0.05）。结论 胃癌根治术后Clavien-Dindo并发症分级Ⅱ级及以上并发症发生率为10.53%，其发生与患者基础状态、营养状况及手术相关因素密切相关。术后并发症不仅影响围手术期安全性，也与长期生存不良相关。pTNM分期仍是影响预后的最重要因素。

Abstract:

Background and Aims Postoperative complications remain a major factor affecting both short-term recovery and long-term survival in patients undergoing radical gastrectomy for gastric cancer. However, large-scale real-world evidence regarding perioperative complications and prognosis after radical gastrectomy is still limited. This study aimed to investigate the incidence of postoperative complications, long-term survival outcomes, and their associated risk factors using a real-world single-center cohort.Methods A retrospective cohort study was conducted including patients who underwent radical gastrectomy for gastric cancer at Hunan Cancer Hospital between January 2011 and December 2023. Postoperative complications were evaluated according to the Clavien-Dindo classification, and grade Ⅱ or higher complications were defined as clinically significant events. Logistic regression analysis was used to identify independent risk factors for postoperative complications. Overall survival (OS) was estimated using the Kaplan-Meier method, and independent prognostic factors were analyzed using Cox proportional hazards regression models.Results A total of 5 111 patients were included, among whom 538 (10.53%) developed 693 events of postoperative complications of Clavien-Dindo grade Ⅱ or higher. The most common complications were pulmonary infection (3.1%), intra-abdominal infection (2.3%), pleural effusion (1.8%), intra-abdominal effusion (1.0%), and anastomotic leakage (0.9%). Perioperative mortality occurred in 30 patients (0.59%). Multivariate logistic regression analysis identified age ≥65 years, comorbidities, preoperative albumin <35 g/L, operative time ≥240 min, intraoperative blood loss ≥300 mL, open surgery, and total gastrectomy as independent risk factors for postoperative complications (all P<0.05). The estimated 5-year OS rate for the entire cohort was 62.5%. Multivariate Cox regression analysis demonstrated that age ≥65 years, low body mass index (BMI), total gastrectomy, perioperative blood transfusion, postoperative complications, and advanced pTNM stage were independent predictors of poor OS (all P<0.05).Conclusion The incidence of clinically significant postoperative complications after radical gastrectomy was 10.53%, and these complications were closely associated with patient condition, nutritional status, and surgical factors. Postoperative complications adversely affected not only perioperative safety but also long-term survival. Tumor pTNM stage remained the most important prognostic factor.