DOI QR코드

DOI QR Code

Prognostic Implications of Postoperative Infectious Complications in Non-Small Cell Lung Cancer

  • Jang, Hyo-Jun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Song, Jae Won (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Cho, Sukki (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Kim, Kwhanmien (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Jheon, Sanghoon (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital)
  • Received : 2017.08.02
  • Accepted : 2017.09.18
  • Published : 2018.02.05

Abstract

Background: Few studies have evaluated the long-term impact of postoperative infectious complications in patients with non-small cell lung cancer (NSCLC). We aimed to determine the impact of infectious complications on long-term outcomes after surgical resection for NSCLC. Methods: We performed a retrospective study of 1,380 eligible patients who underwent pulmonary resection for NSCLC from 2003 to 2012. Complications were divided into infectious complications and non-infectious complications. Kaplan-Meier survival analysis was used to compare unadjusted 5-year cancer-specific survival (CSS) rates and recurrence-free survival (RFS) rates. Cox regression was used to determine the impact of infectious complications on 5-year CSS and RFS. Results: The rate of total complications and infectious complications was 24.3% and 4.3%, respectively. In the node-negative subgroup, the 5-year CSS and RFS rates were 75.9% and 57.1% in patients who had infectious complications, compared to 87.9% and 78.4% in patients who had no complications. Infectious complications were a negative prognostic factor for 5-year RFS (hazard ratio, 1.92; 95% confidence interval, 1.00-3.69; p=0.049). In the node-positive subgroup, the 5-year CSS rate and RFS were 44.6% and 48.4% in patients who had infectious complications, compared to 70.5% and 48.4% for patients who had no complications. Conclusion: Postoperative infectious complications had a negative impact on CSS and RFS in node-negative NSCLC. Our findings may help improve risk assessment for tumor recurrence after pulmonary resection for node-negative NSCLC.

Keywords

References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011;61:69-90. https://doi.org/10.3322/caac.20107
  2. Hayat MJ, Howlader N, Reichman ME, Edwards BK. Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program. Oncologist 2007;12:20-37. https://doi.org/10.1634/theoncologist.12-1-20
  3. Rueth NM, Andrade RS. Is VATS lobectomy better: perioperatively, biologically and oncologically? Ann Thorac Surg 2010;89:S2107-11. https://doi.org/10.1016/j.athoracsur.2010.03.020
  4. Villamizar NR, Darrabie MD, Burfeind WR, et al. Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. J Thorac Cardiovasc Surg 2009; 138:419-25. https://doi.org/10.1016/j.jtcvs.2009.04.026
  5. Tan HJ, Hafez KS, Ye Z, Wei JT, Miller DC. Postoperative complications and long-term survival among patients treated surgically for renal cell carcinoma. J Urol 2012; 187:60-6. https://doi.org/10.1016/j.juro.2011.09.031
  6. Murthy BL, Thomson CS, Dodwell D, et al. Postoperative wound complications and systemic recurrence in breast cancer. Br J Cancer 2007;97:1211-7. https://doi.org/10.1038/sj.bjc.6604004
  7. Rutegard M, Lagergren P, Rouvelas I, Mason R, Lagergren J. Surgical complications and long-term survival after esophagectomy for cancer in a nationwide Swedish cohort study. Eur J Surg Oncol 2012;38:555-61. https://doi.org/10.1016/j.ejso.2012.02.177
  8. Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer. Ann Surg Oncol 2013;20:1575-83. https://doi.org/10.1245/s10434-012-2720-9
  9. Hayashi T, Yoshikawa T, Aoyama T, et al. Impact of infectious complications on gastric cancer recurrence. Gastric Cancer 2015;18:368-74. https://doi.org/10.1007/s10120-014-0361-3
  10. Mavros MN, de Jong M, Dogeas E, Hyder O, Pawlik TM. Impact of complications on long-term survival after resection of colorectal liver metastases. Br J Surg 2013;100: 711-8. https://doi.org/10.1002/bjs.9060
  11. Katoh H, Yamashita K, Wang G, Sato T, Nakamura T, Watanabe M. Anastomotic leakage contributes to the risk for systemic recurrence in stage II colorectal cancer. J Gastrointest Surg 2011;15:120-9. https://doi.org/10.1007/s11605-010-1379-4
  12. Artinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH. Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg 2015;261:497-505. https://doi.org/10.1097/SLA.0000000000000854
  13. Matsuda A, Matsumoto S, Seya T, et al. Does postoperative complication have a negative impact on long-term outcomes following hepatic resection for colorectal liver metastasis?: a meta-analysis. Ann Surg Oncol 2013;20: 2485-92. https://doi.org/10.1245/s10434-013-2972-z
  14. Rueth NM, Parsons HM, Habermann EB, et al. The long-term impact of surgical complications after resection of stage I nonsmall cell lung cancer: a population-based survival analysis. Ann Surg 2011;254:368-74. https://doi.org/10.1097/SLA.0b013e31822150fe
  15. Andalib A, Ramana-Kumar AV, Bartlett G, Franco EL, Ferri LE. Influence of postoperative infectious complications on long-term survival of lung cancer patients: a population-based cohort study. J Thorac Oncol 2013;8:554-61. https://doi.org/10.1097/JTO.0b013e3182862e7e
  16. The Society of Thoracic Surgeons. The Society of Thoracic Surgeons Database 2014 [Internet]. Chicago (IL): The Society of Thoracic Surgeons; 2014 [cited 2017 Aug 1]. Available from: https://www.sts.org/.
  17. Richards CH, Platt JJ, Anderson JH, McKee RF, Horgan PG, McMillan DC. The impact of perioperative risk, tumor pathology and surgical complications on disease recurrence following potentially curative resection of colorectal cancer. Ann Surg 2011;254:83-9. https://doi.org/10.1097/SLA.0b013e31821fd469
  18. Eriksen MT, Wibe A, Norstein J, Haffner J, Wiig JN; Norwegian Rectal Cancer Group. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis 2005;7:51-7. https://doi.org/10.1111/j.1463-1318.2004.00700.x
  19. Lindner K, Fritz M, Haane C, Senninger N, Palmes D, Hummel R. Postoperative complications do not affect long-term outcome in esophageal cancer patients. World J Surg 2014;38:2652-61. https://doi.org/10.1007/s00268-014-2590-3
  20. Jeys LM, Grimer RJ, Carter SR, Tillman RM, Abudu A. Post operative infection and increased survival in osteosarcoma patients: are they associated? Ann Surg Oncol 2007;14:2887-95. https://doi.org/10.1245/s10434-007-9483-8
  21. Ruckdeschel JC, Codish SD, Stranahan A, McKneally MF. Postoperative empyema improves survival in lung cancer: documentation and analysis of a natural experiment. N Engl J Med 1972;287:1013-7. https://doi.org/10.1056/NEJM197211162872004
  22. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell 2010;140:883-99. https://doi.org/10.1016/j.cell.2010.01.025
  23. McGuirk P, Mills KH. Pathogen-specific regulatory T cells provoke a shift in the Th1/Th2 paradigm in immunity to infectious diseases. Trends Immunol 2002;23:450-5. https://doi.org/10.1016/S1471-4906(02)02288-3
  24. Kidd P. Th1/Th2 balance: the hypothesis, its limitations, and implications for health and disease. Altern Med Rev 2003;8:223-46.
  25. Salvans S, Mayol X, Alonso S, et al. Postoperative peritoneal infection enhances migration and invasion capacities of tumor cells in vitro: an insight into the association between anastomotic leak and recurrence after surgery for colorectal cancer. Ann Surg 2014;260:939-43. https://doi.org/10.1097/SLA.0000000000000958
  26. Alonso S, Pascual M, Salvans S, et al. Postoperative intra-abdominal infection and colorectal cancer recurrence: a prospective matched cohort study of inflammatory and angiogenic responses as mechanisms involved in this association. Eur J Surg Oncol 2015;41:208-14. https://doi.org/10.1016/j.ejso.2014.10.052
  27. Schipper PH, Diggs BS, Ungerleider RM, Welke KF. The influence of surgeon specialty on outcomes in general thoracic surgery: a national sample 1996 to 2005. Ann Thorac Surg 2009;88:1566-72. https://doi.org/10.1016/j.athoracsur.2009.08.055
  28. Park BJ. Is surgical morbidity decreased with minimally invasive lobectomy? Cancer J 2011;17:18-22. https://doi.org/10.1097/PPO.0b013e31820b6d27