Comprehensive Complication Index Predicts Cancer-Specific Survival of Patients with Postoperative Complications after Curative Resection of Gastric Cancer

Tu, Ru Hong; Lin, Jian; Li, Ping; Xie, Jian; Wang, Jia Bin; Lü, Jun; Chen, Qi Yue; Cao, Long Long; Ma, Lin; Zheng, Chao; Changming, Huang

doi:10.1155/2018/4396018

Cited by 24 publications

(23 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Few authors compared the performance of CCI and CDC in other homogeneous surgical procedures, namely, gastrostomies, intestinal resections, cystectomies, liver transplantations, esophagectomies and pancreatectomies [ 20 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Their results are quite consistent with ours in defining CCI as a more precise scale for reporting postoperative morbidity.…”

Section: Discussionmentioning

confidence: 99%

Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma

Giani

Cipriani

Famularo

et al. 2020

Cancers

View full text Add to dashboard Cite

Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien-Dindo complication (CDC) scale to predict excessive length of hospital stay (e-LOS) in patients undergoing liver resection for hepatocellular carcinoma. Methods: Patients were identified from an Italian multi-institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e-LOS were fitted to compare predictive performance. E-LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication. Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set. Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.

show abstract

Section: Discussionmentioning

confidence: 99%

Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma

Giani

Cipriani

Famularo

et al. 2020

Cancers

View full text Add to dashboard Cite

show abstract

“…Gastric cancer investigations[ 5 , 6 ] have also observed association between postoperative complications and lower cancer-specific survival. The authors hypothesize that complications could inhibit immune response to spreading tumor cells leading to decreased survival.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have investigated the possible influence of these postoperative complications on the long-term survival of patients treated because of gastric cancer[ 5 , 6 ], colo-rectal cancer[ 7 ], colo-rectal liver metastases[ 8 ], or squamous cell esophageal carcinoma[ 9 ]. However, there are no data concerning LT with the exception of papers dealing with graft damage after biliary or ischemic complications[ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Influence of postoperative complications on long-term survival in liver transplant patients

Castanedo¹,

Toledo²,

Fernández-Santiago³

et al. 2020

WJGS

View full text Add to dashboard Cite

BACKGROUND Liver transplant (LT) is a complex procedure with frequent postoperative complications. In other surgical procedures such as gastrectomy, esophagectomy or resection of liver metastases, these complications are associated with poorer long-term survival. It is possible this happens in LT but there are not enough data to establish this relationship. AIM To analyze the possible influence of postoperative complications on long-term survival and the ability of the comprehensive complication index (CCI) to predict this. METHODS Retrospective study in a tertiary-level university hospital. The 164 participants were all patients who received a LT from January 2012 to July 2019. The follow-up was done in the hospital until the end of the study or death. Comorbidity and risk after transplantation were calculated using the Charlson and balance of risk (BAR) scores, respectively. Postoperative complications were graded according to the Clavien-Dindo classification and the CCI. To assess the CCI cut-off value with greater prognostic accuracy a receiver operating characteristic (ROC) curve was built, with calculation of the area under the curve (AUC). Overall survival was estimated according to the Kaplan-Meier test and log-rank test. Groups were compared by the Mann-Whitney test. For the multivariable analysis the Cox regression was used. RESULTS The mean follow-up time of the cohort was 37.76 (SD = 24.5) mo. A ROC curve of CCI with 5-year survival was built. The AUC was 0.826 (0.730-0.922), P < 0.001. The cut-off was calculated by means of the Youden index with a result of 35.95. The sensitivity was 84.6% and the specificity 61.3%. Survival curves for comparison of patients with CCI score < 36 vs ≥ 36 were calculated. The estimated 5-year survival was 57.65 and 43.95 months, respectively (log-rank < 0.001). This suggests that patients with more severe complications exhibit worse long-term survival. Other cut-off values were analysed. Comparison between patients with CCI < 33.5 vs > 33.5 (33.5 = median CCI value) showed estimated 5-year survival was 57.4 and 45.71 months, respectively (log-rank < 0.0001). Dividing patients according to the mode CCI value (20.9) showed an estimated 5-year survival of 60 mo for a CCI below 20.9 vs 57 mo for a CCI above 20.9 (log-rank = 0.147). The univariate analysis did not show any association between individual complications and long-term survival. A multivariate analysis was carried out to analyse the possible influence of CCI, Charlson comorbidity index, BAR and hepatocellular carcinoma on survival. Only the CCI score showed significant influence on long-term survival. CONCLUSION A complicated postoperative period – well-defined by means of the CCI score – can influence not only short-term survival, but also long-term survival.

show abstract

“…This might be related to postoperative weight loss and worsened nutritional status, which could, along with previous comorbidities, lead to performance status decline and worse overall survival. However, it has also been shown that complications impact on cancer‐specific survival, likely as a result of less compliance with adjuvant treatments; such effect was observed both for morbidity as a whole and for severity‐stratified events.…”

Section: Introductionmentioning

confidence: 99%

Predicting overall and major postoperative morbidity in gastric cancer patients

Coimbra

Jesus

Franco

et al. 2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background Postoperative complications after gastric cancer resection vary in different series and they might have a significant impact in long‐term outcomes. Our aim was to build a prediction rule on gastric cancer patients' overall and major morbidity risks. Methods This retrospective study included 1223 patients from a single center who were resected between 1992 and 2016. Overall and major morbidity predictors were identified through multiple logistic regression. Models' performances were assessed through discrimination, calibration, and cross‐validation, and nomograms were constructed. Results The mean age was 61.3‐year old and the male gender was more frequent (60%). The most common comorbidities were hypertension (HTN), diabetes, and chronic obstructive pulmonary disease (COPD). A D2‐distal gastrectomy was the most frequent procedure and 87% of all lesions were located in the middle or distal third. Age, COPD, coronary heart disease, chronic liver disease, pancreatic resection, and operative time were independent predictors of overall and major morbidity. The extent of resection and splenectomy was associated with overall events and HTN with major ones. Both models were very effective in predicting events among patients at higher risk. Conclusions The overall and major morbidity models and nomograms included clinical‐ and surgical‐related data that were very effective in predicting events, especially for high‐risk patients.

show abstract

Comprehensive Complication Index Predicts Cancer-Specific Survival of Patients with Postoperative Complications after Curative Resection of Gastric Cancer

Cited by 24 publications

References 32 publications

Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma

Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma

Influence of postoperative complications on long-term survival in liver transplant patients

Predicting overall and major postoperative morbidity in gastric cancer patients

Contact Info

Product

Resources

About