Abstract 1397P
Background
Postoperative infectious complications have been identified as negative prognosticator in primary surgery for gastric cancer. This study investigated the prognostic impact of infectious complications in patients who received neoadjuvant chemotherapy by analyzing the data of JCOG0501 phase III trial which compared primary surgery followed by adjuvant S-1 (arm A) with neoadjuvant chemotherapy with S-1/CDDP followed by surgery and adjuvant S-1 (arm B) but could not show survival superiority of arm B to arm A.
Methods
Among 316 patients who were enrolled in the JCOG0501, this study examined the patients who received macroscopically curative gastrectomy with nodal dissection. Grade 2 or more anastomotic leakage, pancreatic fistula, abdominal abscess, intrathoracic abscess, surgical site infection, and pneumonia were evaluated by CTCAE v3.0 and were defined as infectious complications. Overall survival (OS) from surgery was compared between the patients who developed infectious complications (IC group) and did not (Non-IC group).
Results
142 of 158 in arm A and 132 of 158 in arm B had received R0/R1 resection. Infectious complications were observed in 28 (19.7%) in arm A and 15 (11.4%) in arm B. The OS of all 274 patients was 68.8% in Non-IC group and 62.8% in IC group at 3-years and was 53.8% in Non-IC group and 53.1% in IC group at 5-years (HR 0.979, 95% CI [0.622-1.540], p=0.9257). The OS of arm A was 69.3% in Non-IC group and 53.6% in IC group at 3-years and was 51.6% in Non-IC group and 42.9% in IC group at 5-years (HR 1.220, 95% CI [0.714-2.084], p=0.4671) but that of arm B was 68.4% in Non-IC group and 80.0% in IC group at 3-years and was 55.9% in Non-IC group and 73.3% in IC group at 5-years (HR 0.567, 95% CI [0.228-1.412], p=0.2229). In the subset analyses, this upsetting by infectious complications was evident in type 4 (HR 1.043 in arm A and HR 0.386 in arm B).
Conclusions
Infectious complications did not worsen the OS in JCOG0501, especially in patients who had type 4 and received NAC before surgery. Prognostic impact of infectious complications may be different depending on macroscopic type or chemotherapy before surgery.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.