The Impact of Body Mass Index on the Surgical Outcomes of Patients With Gastric Cancer

Abstract

This study aimed to investigate the impact of body mass index (BMI) on the short-term and long-term results of a large cohort of gastric cancer (GC) patients undergoing gastrectomy.Recently, the “obesity paradox” has been proposed, referring to the paradoxically “better” outcomes of overweight and obese patients compared with nonoverweight patients. The associations between BMI and surgical outcomes among patients with GC remain controversial.A single-institution cohort of 1249 GC patients undergoing gastrectomy between 2000 and 2010 were categorized to low-BMI (<18.49 kg/m2), normal-BMI (18.50–24.99 kg/m2), and high-BMI (≥25.00 kg/m2) groups. The postoperative complications were classified according to the Clavien-Dindo system, and their severity was assessed by using the Comprehensive Complication Index (CCI). The impact of BMI on the postoperative complications and overall survival was analyzed.There were 908, 158, and 182 patients in the normal-BMI, low-BMI, and high-BMI groups, respectively. The overall morbidity in the high-BMI group (24.7%) was higher than that in either the low-BMI or the normal-BMI group (20.9% and 15.5%, respectively; P = 0.006), but the mean CCI in the low-BMI group was significantly higher (8.32 ± 19.97) than the mean CCI in the normal-BMI and high-BMI groups (3.76 ± 11.98 and 5.58 ± 13.07, respectively; P < 0.001). The Kaplan–Meier curve and the log-rank test demonstrated that the low-BMI group exhibited the worst survival outcomes compared with the normal-BMI group, whereas the high-BMI group exhibited the best survival outcomes (P < 0.001). In multivariate analysis, BMI was identified as an independent prognostic factor. In the stage-specific subgroup analysis, a low BMI was associated with poorer survival in the cases of stage III–IV diseases.Low BMI was associated with more severe postoperative complications and poorer prognosis. Despite a higher risk of mild postoperative complications, the high-BMI patients exhibited paradoxically “superior” survival outcomes compared with the normal-BMI patients. These findings confirm the “obesity paradox” in GC patients undergoing gastrectomy.

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

“…Interestingly, Chen et al 63. have concluded that high‐BMI patients exhibit paradoxically ‘superior’ survival outcomes compared with normal‐BMI patients despite the higher risk of mild postoperative complications.…”

A Novel Prognostic Score, Based on Preoperative Nutritional Status, Predicts Outcomes of Patients after Curative Resection for Gastric Cancer

“…The BMI was calculated as previously reported (< 18.5 kg/m 2 , ≥ 18.5 to < 25.0 kg/m 2 , ≥ 25.0 kg/m 2 ) and the preoperative body weight loss was categorized as ''<5% of body weight'' or ''≥5% of body weight'' 15, 22.…”

“…Study of Lien et al revealed that serum albumin levels were independent factors correlated with prognosis in GC 14. A recent study, including 1249 cases, shown that a low BMI was associated with poorer prognosis in stage III-IV GC patients 15. Furthermore, our previous study reported that preoperative weight loss independently predicted overall survival (OS) in GC 16.…”

Gastric cancer, nutritional status, and outcome

“…Recently, studies have proved that several nutrition-based indices, such as the prognostic nutritional index (PNI), body mass index (BMI), serum albumin, and preoperative body weight loss, have important prognostic value across varied malignancies, including GC 9–12. A study of 1,249 cases from Chen et al found that a low BMI might be associated with poorer survival among patients with stage III–IV GC 13. Hinata et al reported that impaired performance status was associated with an unfavorable prognosis in patients with urothelial carcinoma of the bladder who underwent radical cystectomy 14.…”