| Background:Infectious complications(ICs)are very easy to appear in the surgical field.Systemic cytokine release increases due to inflammatory response caused by infectious complications,which induce the growth of residual tumor cells.It may have a significant negative effect on the prognosis of patients who have undergone radical gastric cancer surgery.In recent years,this neoadjuvant chemotherapy treatment model has been recognized worldwide for gastric cancer,but some scholars believe that neoadjuvant chemotherapy increases the incidence of infectious complications.In this case,the clinical safety of neoadjuvant chemotherapy seems worthy of our doubt.This article explores the relationship between neoadjuvant chemotherapy and prognosis who have infectious complications after surgery,and compares whether this effect is the same at different histological response.Methods: The article retrospectively collected 158 patients who underwent radical gastric cancer after neoadjuvant chemotherapy in the Department of gastric surgery in the Liaoning Cancer Hospital from January 2012 to June 2018.The characteristics and pathology of perioperative patients were recorded in detail.The enrolled cases were selected as two groups: patients with infectious complications as the IC group,patients without infectious complications as the NIC group,according to the Clavian-Dindo grading criteria.Whether neoadjuvant chemotherapy cancel out the negative impact of morbidity on the survival by compared overall survival(OS)and disease-free survival(DFS)between two groups.At the same time,patients with different histological response were analyzed to assess whether this effect was affected by different histological response.We use SPSS21.0 system software for statistical analysis.In the clinical characteristics of the enrolled cases,the measurement data were statistically analyzed using the Mann-Whitney U test and expressed in the form of mean ± standard deviation,and the count data were compared using the chi square test in the form of ratio.Analysis of OS and DFS is performed by Kaplan-Meier curve method.In this study,univariate and multivariate variables were analyzed and discussed through the COX proportional hazard model.Defined as statistically different when P is less than 0.05.Results: Of all 158 patients,28 people(17.7%)were in the IC group and 130 people(82.3%)were in the NIC group,the clinical characteristics of the two groups were compared during the perioperative period.Compare the effects of sex,age,tumor location,chemotherapy regimen,macroscopic type,operative procedure,operation time,intraoperative bleeding and extent of lymphadenectomy,pathological stage after neoadjuvant chemotherapy,TRG grading on two groups of patients.The results suggest that the IC group has a higher intraoperative blood loss than the NIC group,P =0.049.None of the remaining parameters of the two cohorts were statistically significant.The three-year OS of the IC group and the NIC group were 51.4% and 65.4%.There was no significant difference between the two groups(p = 0.090).The 3-year DFS for the two cohorts were 27.2% and 22.5%,respectively,it don't have statistical difference(P=0.389).In univariate analysis,surgery time(HR =1.88,P =0.028),yp T factor(HR =12.03,P =0.01),yp N factor(hr =5.34,p =0.001)were connected with survival.This is not affected by these factors including age(hr =1.51,p =0.169),sex(hr =1.72,p =0.256),intraoperative bleeding(hr =1.27,p =0.424),infectious complications(hr =0.57,p =0.10),TRG grade(hr =1.20,p =0.645),chemotherapy regimen(p =0.55).The yp T factor(HR =7.783,P =0.044)and yp N factor(HR =3.567,P =0.016)were independent risk factors affecting survival in a multi-factor COX regression model.Among 158 patients,107 had specific TRG grading information.There were 76 cases with TRG1-3(71.0%)and 31 cases with TRG4-5(29.0%).Survival analysis of patients with TRG1-3 and TRG4-5 were performed to compare the OS in IC groups and NIC groups.The final results showed that the difference in both corhorts was not statistically significant regardless of TRG grading.Conclusions: Negative prognosis due to infectious complications in advanced gastric cancer cases can be eliminated by neoadjuvant chemotherapy,and this effect is not affected by histological response and tumor type.The mechanism may be related to the role of chemotherapeutic drugs in immunomodulation as a potential immunomodulator to enhance the immunogenicity of tumor cells and to promoting antitumor immune response,but more large-scale clinical studies are needed to prove this point. |
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