Effect of complication grade on survival following curative gastrectomy for carcinoma

Table 1 Case characteristics n (%)

Characteristic	Complication group				F/χ2	P value
	No (n = 446)	Grade I (n = 105)	Grade II (n = 106)	Grade III (n = 94)
Age (yr)					24.064	< 0.001
≤ 65	239 (53.6)	74 (70.5)	39 (36.8)	50 (53.2)
> 65	207 (46.4)	31 (29.5)	67 (63.2)	44 (46.8)
Gender					10.265	0.016
Male	302 (67.7)	62 (59.0)	83 (78.3)	69 (73.4)
Female	144 (32.3)	43 (41.0)	23 (21.7)	25 (26.6)
Other diseases					34.383	< 0.001
No	358 (80.3)	87 (82.9)	70 (66.0)	52 (55.3)
Yes	88 (19.7)	18 (17.1)	36 (34.0)	42 (44.7)
BMI (kg/m2)					14.640	0.002
Normal	348 (78.0)	83 (79.0)	72 (67.9)	58 (61.7)
Abnormal	98 (22.0)	22 (21.0)	34 (32.1)	36 (38.3)
Laboratory findings
WBC (102/mm3)	6.5 ± 2.1	6.4 ± 2.3	6.6 ± 2.3	6.4 ± 2.2	0.311	0.733
Serum albumin (mg/dL)	40.3 ± 5.7	40.1 ± 5.0	41.1 ± 5.6	40.2 ± 6.0	0.700	0.497
Tumor size (mm)					3.728	0.292
< 5 cm	178 (39.9)	46 (43.8)	36 (34.0)	31 (33.0)
≥ 5 cm	268 (60.1)	59 (56.2)	70 (66.0)	63 (67.0)
Intraoperative blood loss (mL)					9.875	0.020
< 200	211 (47.3)	55 (52.4)	39 (36.8)	33 (35.1)
≥ 200	235 (52.7)	50 (47.6)	67 (63.2)	61 (64.9)
Tumor location					23.550	0.005
Lower 1/3	204 (45.7)	11 (10.5)	40 (37.7)	27 (28.7)
Middle 1/3	48 (10.8)	11 (10.5)	9 (8.5)	10 (10.6)
Upper 1/3	111 (24.9)	57 (54.3)	39 (36.8)	36 (38.3)
2/3 or more	83 (18.6)	26 (24.8)	18 (17.0)	21 (22.3)
Histology					5.596	0.133
Differentiated	147 (33.0)	27 (25.7)	43 (40.6)	34 (36.2)
Undifferentiated	299 (67.0)	78 (74.3)	63 (59.4)	60 (63.8)
Extranodal metastasis					17.533	0.001
Positive	70 (15.7)	18 (17.1)	19 (17.9)	32 (34.0)
Negative	376 (84.3)	87 (82.9)	87 (82.1)	62 (66.0)
Serosal invasion					3.734	0.292
No	90 (20.2)	25 (23.8)	18 (17.0)	13 (13.8)
Yes	356 (79.8)	80 (76.2)	88 (83.0)	81 (86.2)
Lymph node metastasis					23.866	0.005
pN0	129 (28.9)	32 (30.5)	35 (33.0)	14 (14.9)
pN1	57 (12.8)	17 (16.2)	14 (13.2)	28 (29.8)
pN2	112 (25.1)	20 (19.0)	23 (21.7)	20 (21.3)
pN3	148 (33.2)	36 (34.4)	34 (32.1)	32 (34.0)
TNM stage					39.915	< 0.001
I	35 (7.8)	12 (11.4)	7 (6.6)	4 (4.3)
II	101 (22.6)	28 (26.7)	23 (21.7)	22 (23.4)
III	291 (65.2)	62 (59.0)	61 (57.5)	50 (53.2)
IV	19 (4.3)	3 (2.9)	15 (14.2)	18 (19.1)
Chemotherapy					19.76	< 0.001
Yes	261 (58.5)	72 (68.6)	45 (42.5)	43 (45.7)
No	185 (41.5)	33 (31.4)	61 (57.5)	51 (54.3)
Type of gastrectomy					1.004	0.800
Subtotal	315 (70.6)	71 (67.6)	74 (32.4)	62 (66.0)
Total	131 (29.4)	34 (32.4)	32 (30.2)	32 (34.0)

Table 2 Survival analysis of all patients with gastric cancer

Characteristic	S	5-yr OS	Univariate analysis		Multivariate analysis
			χ2	P value	HR (95%CI)	P value
Age (yr)			15.816	< 0.001	1.378 (1.147-1.654)	0.001
≤ 65	402	42.8
> 65	349	28.7
Gender			1.842	0.175
Male	516	34.3
Female	235	40.9
Other diseases			2.457	0.117
No	567	37.2
Yes	184	33.7
BMI			1.675	0.196
Normal	561	37.6
Abnormal	190	32.6
Tumor size			57.692	< 0.001	1.296 (1.049-1.600)	0.016
< 5 cm	291	52.9
≥ 5 cm	460	25.9
Intraoperative blood loss (mL)			22.678	< 0.001	1.259 (1.038-1.526)	0.019
< 200	338	45.3
≥ 200	413	29.1
Tumor location			29.940	< 0.001	1.078 (0.99-01.173)	0.086
Upper 1/3	189	31.2
Middle 1/3	78	37.2
Lower 1/3	336	44.6
2/3 or more	148	23.0
Histology			0.895	0.344
Differentiated	251	37.8
Undifferentiated	500	35.6
Extranodal metastasis			42.214	< 0.001	1.190 (0.956-1.482)	0.120
Positive	139	18.7
Negative	612	40.5
Serosal invasion			44.226	< 0.001	1.185 (0.878-1.600)	0.266
No	146	61.0
Yes	605	30.4
Lymph node metastasis			159.593	< 0.001	1.342 (1.211-1.487)	< 0.001
pN0	210	66.2
pN1	116	38.8
pN2	175	28.0
pN3	250	15.6
TNM stage			182.016	< 0.001	1.525 (1.238-1.879)	< 0.001
I	58	79.3
II	174	59.2
III	464	25.9
IV	55	5.6
Chemotherapy			0.420	0.517
Yes	421	35.2
No	330	37.6
Type of gastrectomy			13.241	< 0.001	1.073 (0.881-1.307)	0.485
Subtotal	522	40.2
Total	229	27.5
Complication grade			131.080	< 0.001	1.456 (1.343-1.579)	< 0.001
None	446	43.0
GradeI	105	42.5
GradeII	106	25.5
GradeIII	94	9.6

Table 3 Risk factors associated with all levels of complication grade

Characteristic	Grade I		Grade II		Grade III
	Multivariate analysis		Multivariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
Lymph node metastasis	1.947 (1.506-2.517)	< 0.001	1.577 (1.208-2.058)	0.001
Age			1.751 (1.044-2.939)	0.034
Tumor size	1.913 (1.059-3.453)	0.031
Intraoperative blood loss	1.850 (1.063-3.222)	0.030			2.099 (1.288-3.421)	0.003
TNM stage					1.607 (1.158-2.228)	0.005
Chemotherapy					2.354 (1.451-3.819)	< 0.001

TNM: Tumor-node-metastasis.

Table 4 Tumor-node-metastasis-stratified analysis of the overall survival

	Grade I	Grade II	Grade III	χ2	P value
	5-yr OS	5-yr OS	5-yr OS
TNM
I	83.3	57.1	50.0	3.094	0.213
II	67.9	47.8	13.6	24.908	< 0.001
III	25.8	18.0	8.0	15.121	0.001
IV	0	5.3	0	2.387	0.303

OS: Overall survival; TNM: Tumor-node-metastasis.