Postoperative Prolonged Inflammatory Response as a Poor Prognostic Factor After Curative Resection for Gastric Cancer

Postoperative inflammatory complications are associated with poorer prognosis in gastrointestinal malignancies. The aims of this study were to clarify the impact of postoperative inflammation itself on overall survival (OS) and relapse-free survival (RFS) in advanced gastric cancer patients. We retrospectively analyzed 490 patients who underwent curative resection for pStage II and III gastric cancer from 2005 to 2008. We evaluated postoperative inflammation based on duration of hyperthermia (body temperature >= 38 A degrees C) and leukocytosis (>= 12,000/A mu L-1). OS and RFS were compared between a prolonged inflammation group and non-prolonged inflammation group. Multivariate analysis using the Cox proportional hazard model was performed to identify independent prognostic factors. The prolonged inflammation group comprised 57 (11.7%) patients who had hyperthermia for 4 days or longer and 42 (8.6%) patients who had leukocytosis for 7 days or longer. OS and RFS were significantly worse in the prolonged hyperthermia group (OS: hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.19-2.73, P = 0.004; RFS: HR 1.66, 95% CI 1.08-2.45, P = 0.015). The prolonged leukocytosis group also showed significantly worse OS (HR 1.92, 95% CI 1.19-2.96, P = 0.004) and RFS (HR 1.90, 95% CI 1.19-2.88, P = 0.004). Multivariate analysis identified prolonged hyperthermia as an independent factor for predicting poor prognosis (OS: HR 1.77, 95% CI 1.13-2.68, P = 0.013; RFS: HR 1.60; 95% CI 1.03-2.39, P = 0.038). Prolonged hyperthermia and leukocytosis after curative gastrectomy were associated with poorer OS and RFS in advanced gastric cancer patients.