Interaction of Postoperative Morbidity and Receipt of Adjuvant Therapy on Long-Term Survival After Resection for Gastric Adenocarcinoma

Results From the U.S. Gastric Cancer Collaborative

Linda X. Jin, Dominic E. Sanford, Malcolm Hart Squires, Lindsey E. Moses, Yan Yan, George A. Poultsides, Konstantinos I. Votanopoulos, Sharon M. Weber, Mark Bloomston, Timothy M. Pawlik, William G. Hawkins, David C. Linehan, Carl Schmidt, David J. Worhunsky, Alexandra W. Acher, Kenneth Cardona, Clifford S. Cho, David A. Kooby, Edward A. Levine, Emily Winslow & 5 others Neil Saunders, Gaya Spolverato, Graham A. Colditz, Shishir K. Maithel, Ryan C. Fields

Research output: Contribution to journalArticle

Abstract

Background: Postoperative complications (POCs) can negatively impact survival after oncologic resection. POCs may also decrease the rate of adjuvant therapy completion. We evaluated the impact of complications on gastric cancer survival and analyzed the combined effect of complications and adjuvant therapy on survival.Methods: We analyzed 824 patients from 7 institutions of the U.S. Gastric Cancer Collaborative who underwent curative resection for gastric adenocarcinoma between 2000 and 2012. POC were graded using the modified Clavien–Dindo system. Survival probabilities were estimated using the method of Kaplan and Meier and analyzed using multivariate Cox regression. Results: Median follow-up was 35 months. The overall complication rate was 41 %. The 5-year overall survival (OS) and recurrence-free survival (RFS) of patients who experienced complications were 27 and 23 %, respectively, compared with 43 and 40 % in patients who did not have complications (p <0.0001 for OS and RFS). On multivariate analysis, POC remained an independent predictor for decreased OS and RFS (HR 1.3, 95 % CI 1.1–1.6, p = 0.03 for OS; HR 1.3, 95 % CI 1.01–1.6, p = 0.03 for RFS). Patients who experienced POC were less likely to receive adjuvant therapy (OR 0.5, 95 % CI 0.3–0.7, p <0.001). The interaction of complications and failure to receive adjuvant therapy significantly increased the hazard of death compared with patients who had neither complications nor adjuvant therapy (HR 2.3, 95 % CI 1.6–3.2, p <0.001). Conclusions: Postoperative complications adversely affect long-term outcomes after gastrectomy for gastric cancer. Not receiving adjuvant therapy in the face of POC portends an especially poor prognosis following gastrectomy for gastric cancer.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Mar 22 2016

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Stomach Neoplasms
Stomach
Adenocarcinoma
Morbidity
Survival
Therapeutics
Recurrence
Gastrectomy
Multivariate Analysis

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Interaction of Postoperative Morbidity and Receipt of Adjuvant Therapy on Long-Term Survival After Resection for Gastric Adenocarcinoma : Results From the U.S. Gastric Cancer Collaborative. / Jin, Linda X.; Sanford, Dominic E.; Squires, Malcolm Hart; Moses, Lindsey E.; Yan, Yan; Poultsides, George A.; Votanopoulos, Konstantinos I.; Weber, Sharon M.; Bloomston, Mark; Pawlik, Timothy M.; Hawkins, William G.; Linehan, David C.; Schmidt, Carl; Worhunsky, David J.; Acher, Alexandra W.; Cardona, Kenneth; Cho, Clifford S.; Kooby, David A.; Levine, Edward A.; Winslow, Emily; Saunders, Neil; Spolverato, Gaya; Colditz, Graham A.; Maithel, Shishir K.; Fields, Ryan C.

In: Annals of Surgical Oncology, 22.03.2016, p. 1-11.

Research output: Contribution to journalArticle

Jin, LX, Sanford, DE, Squires, MH, Moses, LE, Yan, Y, Poultsides, GA, Votanopoulos, KI, Weber, SM, Bloomston, M, Pawlik, TM, Hawkins, WG, Linehan, DC, Schmidt, C, Worhunsky, DJ, Acher, AW, Cardona, K, Cho, CS, Kooby, DA, Levine, EA, Winslow, E, Saunders, N, Spolverato, G, Colditz, GA, Maithel, SK & Fields, RC 2016, 'Interaction of Postoperative Morbidity and Receipt of Adjuvant Therapy on Long-Term Survival After Resection for Gastric Adenocarcinoma: Results From the U.S. Gastric Cancer Collaborative', Annals of Surgical Oncology, pp. 1-11. https://doi.org/10.1245/s10434-016-5121-7
Jin, Linda X. ; Sanford, Dominic E. ; Squires, Malcolm Hart ; Moses, Lindsey E. ; Yan, Yan ; Poultsides, George A. ; Votanopoulos, Konstantinos I. ; Weber, Sharon M. ; Bloomston, Mark ; Pawlik, Timothy M. ; Hawkins, William G. ; Linehan, David C. ; Schmidt, Carl ; Worhunsky, David J. ; Acher, Alexandra W. ; Cardona, Kenneth ; Cho, Clifford S. ; Kooby, David A. ; Levine, Edward A. ; Winslow, Emily ; Saunders, Neil ; Spolverato, Gaya ; Colditz, Graham A. ; Maithel, Shishir K. ; Fields, Ryan C. / Interaction of Postoperative Morbidity and Receipt of Adjuvant Therapy on Long-Term Survival After Resection for Gastric Adenocarcinoma : Results From the U.S. Gastric Cancer Collaborative. In: Annals of Surgical Oncology. 2016 ; pp. 1-11.
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title = "Interaction of Postoperative Morbidity and Receipt of Adjuvant Therapy on Long-Term Survival After Resection for Gastric Adenocarcinoma: Results From the U.S. Gastric Cancer Collaborative",
abstract = "Background: Postoperative complications (POCs) can negatively impact survival after oncologic resection. POCs may also decrease the rate of adjuvant therapy completion. We evaluated the impact of complications on gastric cancer survival and analyzed the combined effect of complications and adjuvant therapy on survival.Methods: We analyzed 824 patients from 7 institutions of the U.S. Gastric Cancer Collaborative who underwent curative resection for gastric adenocarcinoma between 2000 and 2012. POC were graded using the modified Clavien–Dindo system. Survival probabilities were estimated using the method of Kaplan and Meier and analyzed using multivariate Cox regression. Results: Median follow-up was 35 months. The overall complication rate was 41 {\%}. The 5-year overall survival (OS) and recurrence-free survival (RFS) of patients who experienced complications were 27 and 23 {\%}, respectively, compared with 43 and 40 {\%} in patients who did not have complications (p <0.0001 for OS and RFS). On multivariate analysis, POC remained an independent predictor for decreased OS and RFS (HR 1.3, 95 {\%} CI 1.1–1.6, p = 0.03 for OS; HR 1.3, 95 {\%} CI 1.01–1.6, p = 0.03 for RFS). Patients who experienced POC were less likely to receive adjuvant therapy (OR 0.5, 95 {\%} CI 0.3–0.7, p <0.001). The interaction of complications and failure to receive adjuvant therapy significantly increased the hazard of death compared with patients who had neither complications nor adjuvant therapy (HR 2.3, 95 {\%} CI 1.6–3.2, p <0.001). Conclusions: Postoperative complications adversely affect long-term outcomes after gastrectomy for gastric cancer. Not receiving adjuvant therapy in the face of POC portends an especially poor prognosis following gastrectomy for gastric cancer.",
author = "Jin, {Linda X.} and Sanford, {Dominic E.} and Squires, {Malcolm Hart} and Moses, {Lindsey E.} and Yan Yan and Poultsides, {George A.} and Votanopoulos, {Konstantinos I.} and Weber, {Sharon M.} and Mark Bloomston and Pawlik, {Timothy M.} and Hawkins, {William G.} and Linehan, {David C.} and Carl Schmidt and Worhunsky, {David J.} and Acher, {Alexandra W.} and Kenneth Cardona and Cho, {Clifford S.} and Kooby, {David A.} and Levine, {Edward A.} and Emily Winslow and Neil Saunders and Gaya Spolverato and Colditz, {Graham A.} and Maithel, {Shishir K.} and Fields, {Ryan C.}",
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TY - JOUR

T1 - Interaction of Postoperative Morbidity and Receipt of Adjuvant Therapy on Long-Term Survival After Resection for Gastric Adenocarcinoma

T2 - Results From the U.S. Gastric Cancer Collaborative

AU - Jin, Linda X.

AU - Sanford, Dominic E.

AU - Squires, Malcolm Hart

AU - Moses, Lindsey E.

AU - Yan, Yan

AU - Poultsides, George A.

AU - Votanopoulos, Konstantinos I.

AU - Weber, Sharon M.

AU - Bloomston, Mark

AU - Pawlik, Timothy M.

AU - Hawkins, William G.

AU - Linehan, David C.

AU - Schmidt, Carl

AU - Worhunsky, David J.

AU - Acher, Alexandra W.

AU - Cardona, Kenneth

AU - Cho, Clifford S.

AU - Kooby, David A.

AU - Levine, Edward A.

AU - Winslow, Emily

AU - Saunders, Neil

AU - Spolverato, Gaya

AU - Colditz, Graham A.

AU - Maithel, Shishir K.

AU - Fields, Ryan C.

PY - 2016/3/22

Y1 - 2016/3/22

N2 - Background: Postoperative complications (POCs) can negatively impact survival after oncologic resection. POCs may also decrease the rate of adjuvant therapy completion. We evaluated the impact of complications on gastric cancer survival and analyzed the combined effect of complications and adjuvant therapy on survival.Methods: We analyzed 824 patients from 7 institutions of the U.S. Gastric Cancer Collaborative who underwent curative resection for gastric adenocarcinoma between 2000 and 2012. POC were graded using the modified Clavien–Dindo system. Survival probabilities were estimated using the method of Kaplan and Meier and analyzed using multivariate Cox regression. Results: Median follow-up was 35 months. The overall complication rate was 41 %. The 5-year overall survival (OS) and recurrence-free survival (RFS) of patients who experienced complications were 27 and 23 %, respectively, compared with 43 and 40 % in patients who did not have complications (p <0.0001 for OS and RFS). On multivariate analysis, POC remained an independent predictor for decreased OS and RFS (HR 1.3, 95 % CI 1.1–1.6, p = 0.03 for OS; HR 1.3, 95 % CI 1.01–1.6, p = 0.03 for RFS). Patients who experienced POC were less likely to receive adjuvant therapy (OR 0.5, 95 % CI 0.3–0.7, p <0.001). The interaction of complications and failure to receive adjuvant therapy significantly increased the hazard of death compared with patients who had neither complications nor adjuvant therapy (HR 2.3, 95 % CI 1.6–3.2, p <0.001). Conclusions: Postoperative complications adversely affect long-term outcomes after gastrectomy for gastric cancer. Not receiving adjuvant therapy in the face of POC portends an especially poor prognosis following gastrectomy for gastric cancer.

AB - Background: Postoperative complications (POCs) can negatively impact survival after oncologic resection. POCs may also decrease the rate of adjuvant therapy completion. We evaluated the impact of complications on gastric cancer survival and analyzed the combined effect of complications and adjuvant therapy on survival.Methods: We analyzed 824 patients from 7 institutions of the U.S. Gastric Cancer Collaborative who underwent curative resection for gastric adenocarcinoma between 2000 and 2012. POC were graded using the modified Clavien–Dindo system. Survival probabilities were estimated using the method of Kaplan and Meier and analyzed using multivariate Cox regression. Results: Median follow-up was 35 months. The overall complication rate was 41 %. The 5-year overall survival (OS) and recurrence-free survival (RFS) of patients who experienced complications were 27 and 23 %, respectively, compared with 43 and 40 % in patients who did not have complications (p <0.0001 for OS and RFS). On multivariate analysis, POC remained an independent predictor for decreased OS and RFS (HR 1.3, 95 % CI 1.1–1.6, p = 0.03 for OS; HR 1.3, 95 % CI 1.01–1.6, p = 0.03 for RFS). Patients who experienced POC were less likely to receive adjuvant therapy (OR 0.5, 95 % CI 0.3–0.7, p <0.001). The interaction of complications and failure to receive adjuvant therapy significantly increased the hazard of death compared with patients who had neither complications nor adjuvant therapy (HR 2.3, 95 % CI 1.6–3.2, p <0.001). Conclusions: Postoperative complications adversely affect long-term outcomes after gastrectomy for gastric cancer. Not receiving adjuvant therapy in the face of POC portends an especially poor prognosis following gastrectomy for gastric cancer.

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DO - 10.1245/s10434-016-5121-7

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JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

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