Perioperative risk factors for prognosis in patients undergoing radical esophagectomy: A retrospective study

Table 1 Univariate Cox analysis of baseline characteristics for overall survival, n (%)

Baseline characteristic	n = 378	Hazard ratio	95%CI	P value
Age
<65 years	215 (56.88)	1.00	Reference	-
≥ 65 years	163 (43.12)	1.52	1.18-1.96	0.001
Gender
Male	292 (77.25)	1.00	Reference	-
Female	86 (22.75)	0.89	0.67-1.19	0.44
BMI (kg/m²), mean ± SD	23.10 ± 3.20	0.97	0.93-1.02	0.24
Hypertension
No	246 (65.08)	1.00	Reference	-
Yes	132 (34.92)	1.28	0.99-1.65	0.06
Diabetes
No	298 (78.84)	1.00	Reference	-
Yes	80 (21.16)	1.31	0.98-1.75	0.07
Smoking history
No	156 (41.27)	1.00	Reference	-
Yes	222 (58.73)	1.22	0.94-1.58	0.13
History of drinking
No	169 (44.70)	1.00	Reference	-
Yes	209 (55.29)	1.15	0.89-1.48	0.28
Chronic gastritis
No	271 (71.69)	1.00	Reference	-
Yes	107 (28.31)	1.12	0.85-1.47	0.43
ASA classification
III	312 (82.54)	1.00	Reference	-
IV	66 (17.46)	1.45	1.08-1.95	0.01
NYHA classification
I	256 (67.72)	1.00	Reference	-
II	89 (23.54)	1.33	0.99-1.78	0.06
III	33 (8.74)	1.68	1.12-2.52	0.01
Glomerular filtration rate
< 90 mL/minute/1.73 m²	142 (37.57)	1.00	Reference	-
≥ 90 mL/minute/1.73 m²	236 (62.43)	0.81	0.63-1.05	0.11

CI: Confidence interval; BMI: Body mass index; ASA: American Society of Anesthesiologists; NYHA: New York Heart Association.

Table 2 Univariate Cox analysis of surgery-related factors for overall survival, n (%)

Surgery-related factors	n = 378	Hazard ratio	95%CI	P value
Type of anesthesia
General anesthesia	203 (53.70)	1.00	Reference	-
Epidural anesthesia	175 (46.30)	0.92	0.71-1.19	0.52
Surgical methods
Open surgery	245 (64.81)	1.00	Reference	-
Minimally invasive surgery	133 (35.19)	0.78	0.60-1.02	0.07
Location of anastomotic site
Cervical	228 (60.32)	1.00	Reference	-
Thoracic	150 (39.68)	1.25	0.97-1.62	0.09
Operative time, minutes, mean ± SD	266.01 ± 83.13	1.00	0.99-1.01	0.05
Duration of analgesic use
≤ 5 days	149 (39.42)	1.00	Reference	-
> 5 days	229 (60.58)	1.62	1.24-2.12	< 0.001
Postoperative radiotherapy or chemotherapy
No	198 (52.38)	1.00	Reference	-
Yes	180 (47.62)	1.45	1.12-1.88	0.01
Postoperative pneumonia
No	265 (70.11)	1.00	Reference	-
Yes	113 (29.89)	1.58	1.21-2.06	0.001
Postoperative pleural effusion
No	284 (75.13)	1.00	Reference	-
Yes	94 (24.87)	1.42	1.07-1.88	0.02

CI: Confidence interval.

Table 3 Univariate Cox analysis of pathological characteristics for overall survival, n (%)

Pathological characteristic	n = 378	Hazard ratio	95%CI	P value
TNM stage
I or II stage	167 (44.18)	1.00	Reference	-
III or IV stage	211 (55.82)	2.85	2.15-3.78	< 0.001
Tumor location
Upper segment	72 (19.05)	1.00	Reference	-
Middle segment	198 (52.38)	0.92	0.66-1.28	0.62
Lower segment	108 (28.57)	0.88	0.61-1.27	0.50
Tumor diameter
< 3 cm	156 (41.27)	1.00	Reference	-
≥ 3 cm	222 (58.73)	1.68	1.29-2.19	< 0.001
Depth of tumor infiltration
On the muscle layer	143 (37.83)	1.00	Reference	-
Subcutaneous muscle layer	235 (62.17)	1.92	1.46-2.52	< 0.001
Histological differentiation
Well differentiated	89 (23.54)	1.00	Reference	-
Moderately differentiated	196 (51.85)	1.58	1.12-2.23	0.01
Poorly differentiated	93 (24.61)	2.42	1.67-3.51	< 0.001
Perineural invasion
No	286 (75.66)	1.00	Reference	-
Yes	92 (24.34)	1.75	1.33-2.30	< 0.001
Tumor thrombus
No	301 (79.63)	1.00	Reference	-
Yes	77 (20.37)	1.89	1.42-2.52	< 0.001
Lymph node metastasis
No	184 (48.68)	1.00	Reference	-
Yes	194 (51.32)	2.32	1.77-3.04	< 0.001

CI: Confidence interval; TNM: Tumor-node-metastasis.

Table 4 Patient characteristics by analgesic use duration after esophagectomy, n (%)

Baseline characteristic	Short-term analgesic use (n = 149)	Long-term analgesic use (n = 229)	t value or χ2	P value
Age			5.87	0.02
< 65 years	96 (64.43)	118 (51.53)
≥ 65 years	53 (35.57)	111 (48.47)
Gender			0.22	0.64
Male	117 (78.52)	175 (76.42)
Female	32 (21.48)	54 (23.58)
BMI (kg/m²), mean ± SD	23.25 ± 3.15	23.01 ± 3.24	0.72	0.47
Hypertension			0.64	0.42
No	107 (71.81)	139 (60.70)
Yes	42 (28.19)	90 (39.30)
Diabetes			0.55	0.46
No	126 (84.56)	172 (75.11)
Yes	23 (15.44)	57 (24.89)
Smoking history			0.74	0.39
No	66 (44.30)	90 (39.30)
Yes	83 (55.70)	139 (60.70)
History of drinking			0.89	0.35
No	71 (47.65)	98 (42.79)
Yes	78 (52.35)	131 (57.21)
Chronic gastritis			0.52	0.47
No	104 (69.80)	167 (72.93)
Yes	45 (30.20)	62 (27.07)
ASA classification			0.65	0.42
III	133 (89.26)	179 (78.17)
IV	16 (10.74)	50 (21.83)
NYHA classification			1.24	0.54
I	108 (72.48)	148 (64.63)
II	34 (22.82)	55 (24.02)
III	7 (4.70)	26 (11.35)
Glomerular filtration rate			2.24	0.14
< 90 mL/minute/1.73 m²	50 (33.56)	92 (40.17)
≥ 90 mL/minute/1.73 m²	99 (66.44)	137 (59.83)

CI: Confidence interval; BMI: Body mass index; ASA: American Society of Anesthesiologists; NYHA: New York Heart Association.

Table 5 Surgery-related factors by analgesic use duration after esophagectomy, n (%)

Surgery-related factors	Short-term analgesic use (n = 149)	Long-term analgesic use (n = 229)	t value or χ2	P value
Type of anesthesia			0.33	0.57
General anesthesia	77 (51.68)	126 (55.02)
Epidural anesthesia	72 (48.32)	103 (44.98)
Surgical methods			1.96	0.17
Open surgery	83 (55.70)	162 (70.74)
Minimally invasive surgery	66 (44.30)	67 (29.26)
Location of anastomotic site			1.34	0.25
Cervical	78 (52.35)	150 (65.50)
Thoracic	71 (47.65)	79 (34.50)
Operative time, minutes, mean ± SD	265.83 ± 76.28	266.35 ± 85.42	1.73	0.09
Duration of analgesic use			2.74	0.10
≤ 5 days	85 (57.05)	113 (49.34)
> 5 days	64 (42.95)	116 (50.66)
Postoperative radiotherapy or chemotherapy			1.84	0.18
No	118 (79.19)	147 (64.19)
Yes	31 (20.81)	82 (35.81)
Postoperative pneumonia			1.95	0.16
No	122 (81.88)	162 (70.74)
Yes	27 (18.12)	67 (29.26)

CI: Confidence interval.

Table 6 Pathological characteristics by analgesic use duration after esophagectomy, n (%)

Pathological characteristic	Short-term analgesic use (n = 149)	Long-term analgesic use (n = 229)	t value or χ²	P value
TNM stage			1.90	0.17
I or II stage	78 (52.35)	88 (38.43)
III or IV stage	71 (47.65)	141 (61.57)
Tumor location			0.16	0.92
Upper segment	29 (19.46)	43 (18.78)
Middle segment	77 (51.68)	121 (52.84)
Lower segment	43 (28.86)	65 (28.38)
Tumor diameter			1.40	0.24
< 3 cm	74 (49.66)	81 (35.37)
≥ 3 cm	75 (50.34)	148 (64.63)
Depth of tumor infiltration			1.13	0.29
On the muscle layer	65 (43.62)	78 (34.06)
Subcutaneous muscle layer	84 (56.38)	151 (65.94)
Histological differentiation			2.74	0.26
Well differentiated	42 (28.19)	47 (20.52)
Moderately differentiated	81 (54.36)	115 (50.22)
Poorly differentiated	26 (17.45)	67 (29.26)
Perineural invasion			1.49	0.22
No	124 (83.22)	162 (70.74)
Yes	25 (16.78)	67 (29.26)
Tumor thrombus			1.22	0.27
No	125 (83.89)	176 (76.86)
Yes	24 (16.11)	53 (23.14)
Lymph node metastasis			1.90	0.17
No	86 (57.72)	98 (42.79)
Yes	63 (42.28)	131 (57.21)

CI: Confidence interval; TNM: Tumor-node-metastasis.

Table 7 Multivariate analysis of survival-related factors in radically resected esophageal squamous cell carcinoma, n (%)

Variables	Hazard ratio	95%CI	P value
TNM staging	-	-	-
Phase I and II	1.00	Reference	-
Phase III and IV	2.31	1.72-3.10	< 0.001
Degree of tumor differentiation	-	-	-
Well differentiated	1.00	Reference	-
Moderately differentiated	1.46	1.02-2.09	0.038
Poorly differentiated	2.15	1.47-3.14	< 0.001
Postoperative analgesics used for more than 5 days	-	-	-
≤ 5 days	1.00	Reference	-
> 5 days	1.43	1.08-1.89	0.012

CI: Confidence interval; TNM: Tumor-node-metastasis.