Table_1_Impact of Type of Postoperative Complications on Long-Term Survival of Gastric Cancer Patients: Results From a High-Volume Institution in China.docx

BackgroundThis study aimed to evaluate the impact of postoperative complication and its etiology on long-term survival for gastric cancer (GC) patients with curative resection.
MethodsFrom January 2009 to December 2014, a total of 1,667 GC patients who had undergone curative gastrectomy were analyzed. Patients with severe complications (SCs) (Clavien–Dindo grade III or higher complications or those causing a hospital stay of 15 days or longer) were separated into a “complication group.” Univariate and multivariate analyses were performed to reveal the relationship between postoperative complications and long-term survival. A 2:1 propensity score matching (PSM) was used to balance baseline parameters between the two groups.
ResultsSCs were diagnosed in 168 (10.08%) patients, including different etiology: infectious complications (ICs) in 111 (6.66%) and non-infectious complications (NICs) in 71 (4.26%) patients. Multivariate analysis showed that presence of SCs (P=0.001) was an independent prognostic factor for overall survival, and further analysis by complication type demonstrated that the deteriorated overall survival was mainly caused by ICs (P=0.004) rather than NICs (P=0.068). After PSM, patients with SCs (p=0.002) still had a significantly decreased overall survival, and the presence of ICs (P=0.002) rather than NICs (P=0.067) showed a negative impact on long-term survival.
ConclusionSerious complications, particularly of an infectious type, may have a negative impact on overall survival of GC patients. However, additional multicenter prospective studies with larger sample size are required to verify this issue.

**背景**：本研究旨在评估接受根治性切除术的胃癌（gastric cancer, GC）患者术后并发症及其病因对其长期生存的影响。
**方法**：本研究纳入2009年1月至2014年12月期间接受根治性胃切除术的1667例胃癌患者进行分析。将发生严重并发症（severe complications, SCs）[即Clavien-Dindo分级Ⅲ级及以上并发症，或导致住院时长≥15天的并发症]的患者划分为"并发症组"。采用单因素及多因素分析探讨术后并发症与长期生存之间的关联，并通过2:1倾向性评分匹配（propensity score matching, PSM）平衡两组患者的基线参数。
**结果**：共计168例（10.08%）患者被诊断为严重并发症，其中感染性并发症（infectious complications, ICs）111例（6.66%），非感染性并发症（non-infectious complications, NICs）71例（4.26%）。多因素分析显示，严重并发症的发生（P=0.001）是总生存期的独立预后因素；进一步按并发症类型分层分析表明，总生存期恶化主要由感染性并发症导致（P=0.004），而非非感染性并发症（P=0.068）。经倾向性评分匹配后，严重并发症组患者的总生存期仍显著降低（P=0.002），且感染性并发症的存在（P=0.002）而非非感染性并发症（P=0.067）对长期生存产生负面影响。
**结论**：严重并发症，尤其是感染性并发症，可能对胃癌患者的总生存期产生负面影响。但仍需开展更大样本量的多中心前瞻性研究以验证该结论。