Which is a more reliable indicator of survival after gastric cancer surgery: Postoperative complication occurrence or C-reactive protein elevation?

• Published in: Journal of surgical oncology Vol. 112; no. 8; pp. 894 - 899
• Main Authors: Saito, Takuro, Kurokawa, Yukinori, Miyazaki, Yasuhiro, Makino, Tomoki, Takahashi, Tsuyoshi, Yamasaki, Makoto, Nakajima, Kiyokazu, Takiguchi, Shuji, Mori, Masaki, Doki, Yuichiro
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 15.12.2015; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Aged, 80 and over; C-reactive protein; C-Reactive Protein - metabolism; Cancer surgery; Clinical outcomes; Disease-Free Survival; Female; gastrectomy; Gastrectomy - mortality; Gastric cancer; Humans; Male; Medical prognosis; Middle Aged; Neoplasm Staging; postoperative complication; Postoperative Complications; Retrospective Studies; Stomach Neoplasms - blood; Stomach Neoplasms - mortality; Stomach Neoplasms - surgery; Survival Rate; postoperative complication; C-reactive protein; gastrectomy; gastric cancer
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.24067

Background and Objectives The impact of postoperative complications on long‐term outcome has been reported in several types of malignancies. However, it is unclear why postoperative complications affect long‐term outcome. The aim of this study is evaluating whether postoperative complication occurrence or C‐reactive protein (CRP) elevation better reflects long‐term outcome in gastric cancer patients. Methods This study included 305 patients who underwent curative surgery for pT2–T4b gastric cancer. Patients were divided into two groups based on the peak CRP value (CRPmax): low (<12 mg/dl) and high CRPmax (≥12 mg/dl). A multivariate analysis was conducted to identify independent prognostic factors for recurrence‐free survival (RFS). Results Postoperative complications (≥Grade II) occurred in 86 of 305 patients (28.2%). Although CRP elevation (P = 0.001) and postoperative complication occurrence (P = 0.045) was each significantly associated with RFS in the univariate analysis, multivariate analysis identified CRP elevation (P = 0.017) but not complication occurrence (P = 0.682) as an independent prognostic factor. Among patients without complications, those in the high CRPmax group had significantly worse RFS than those in the low CRPmax group (P = 0.004). Conclusions CRP elevation is a more reliable indicator of survival after gastric cancer surgery than postoperative complication occurrence. Surgeons should minimize the postoperative inflammatory response to improve prognosis. J. Surg. Oncol. 2015;112:894–899. © 2015 Wiley Periodicals, Inc.