Preoperative Nutritional Deficiency Is a Useful Predictor of Postoperative Outcome in Patients Undergoing Curative Resection for Gastric Cancer

Abstract

BACKGROUND: Preoperative nutritional deficiency (ND) has been shown to be a valuable prognostic factor in urologic malignancies. We aimed to investigate the prognostic value of ND in patients with gastric cancer (GC). METHODS: A single-center cohort of 1026 GC patients undergoing curative resection between 2003 and 2012 was categorized to ND and nutritionally replete (NR) groups. Patients with body mass index <18.5 kg/m2, preoperative albumin <35 g/l, or preoperative weight loss ≥5% of body weight were defined as ND. RESULTS: Of the 1026 patients included in the study, 585 (57.0%) were categorized as ND. Overall survival (OS) at 5 years was 68.5% for ND patients and 44.0% for NR patients (P < .001). Multivariate analysis revealed that ND was a significant predictor of OS (hazard ratio: 1.954; 95% confidence interval: 1.552-2.460; P < .001). In stage-stratified analysis, it was still independently associated with OS in tumor-nodes-metastasis stage II and III (P = .004 and P < .001, respectively). Of note, the prognostic significance of ND was still maintained when stratified by age, sex, anemia, and adjuvant chemotherapy (all Ps < .05). CONCLUSION: Preoperative ND is a novel predictor of outcome in GC, especially in stage II to III GC, and may help clinicians identify high-risk patients for proactive nutritional interventions.

Comprehensive geriatric assessment prediction of postoperative complications in gastrointestinal cancer patients: a meta-analysis

“…A number of assessment tools exist to identify malnutrition in patients with colorectal cancer, but different tools have different diagnostic accuracies and lack a standardized method. 40 , 41 Therefore, it was recommended that a high-accuracy diagnostic test of nutritional tools based on evidence should be used to further determine the predictive value of nutritional status for postoperative complications.…”

Preoperative controlling nutritional status (CONUT) score as a predictor of long-term outcome after curative resection followed by adjuvant chemotherapy in stage II-III gastric Cancer

“…One such factor that has arisen substantial attention is the nutritional and immunological status, which is reported to be associated with the clinical outcomes in various malignancies [ 4 – 6 ]. Several preoperative scoring systems are developed to assess nutritional risk, postoperative complications and long-term outcomes, such as the prognostic nutritional index (PNI), subjective global assessment, and Nutritional Risk Index [ 7 – 9 ].…”

The prognostic impact of pre-treatment cachexia in resectional surgery for oesophagogastric cancer: a meta-analysis and meta-regression

“…All included studies were observational cohort studies, either prospective (50 per cent) 22–26 or retrospective (50 per cent) 27–31 in nature ( Table 1 ). The majority of studies were from Asia (60 per cent) 24 , 25 , 28–31 with the remainder undertaken in Europe 22 , 23 , 26 , 27 . Risk of bias was deemed moderate/high for all 10 studies ( Fig.…”

“…A total of 7186 patients who underwent resection of OG cancer were included in quantitative analyses. Most larger patient cohorts were reported by studies based in Asia ( Table 1 ) 24 , 25 , 28–31 . Median age varied between 59 and 67 years, and a consistent male preponderance was seen, with proportions ranging from 61 to 83 per cent ( Table 2 ).…”

“…The use and nature of anti-cancer therapies was poorly reported, with neoadjuvant and adjuvant treatments being described by only one study 27 and three studies, respectively 28 , 30 , 31 . The types of surgical resection undertaken were described more frequently 22–24 , 27 , 29–31 .…”