Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Lifestyle factors and long-term survival of gastric cancer patients: A large bidirectional cohort study from China
Lu-Lu Zhao, Huang Huang, Yang Wang, Tong-Bo Wang, Hong Zhou, Fu-Hai Ma, Hu Ren, Peng-Hui Niu, Dong-Bing Zhao, Ying-Tai Chen
Lu-Lu Zhao, Yang Wang, Tong-Bo Wang, Hong Zhou, Fu-Hai Ma, Hu Ren, Peng-Hui Niu, Dong-Bing Zhao, Ying-Tai Chen, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Huang Huang, Department of Environmental Health Sciences, Yale University School of Public Health, New Haven, CT 06520, United States
Yang Wang, Department of General Surgery, Beijing Di Tan Hospital, Capital Medical University, Beijing 100015, China
Author contributions: Zhao LL, Huang H and Wang Y contributed equally to this work; All authors made substantial contributions to the intellectual content of this paper.
Supported by National Key R& D Program of China, No. 2017YFC0908300.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College.
Informed consent statement: Patients were not required to give informed consent to the study as the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at yingtaichen@126.com.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ying-Tai Chen, MD, Professor, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Beijing 100021, China. yingtaichen@126.com
Received: December 18, 2019
Peer-review started: December 18, 2019
First decision: January 12, 2020
Revised: March 5, 2020
Accepted: March 19, 2020
Article in press: March 19, 2020
Published online: April 14, 2020
ARTICLE HIGHLIGHTS
Research background
As the gastric cancer patient population grows, lifestyle factors contributing to improved or adverse survival are becoming a focus of increasing interest.
Research motivation
Lifestyle factors such as body mass index (BMI), alcohol drinking, and cigarette smoking, are likely to impact the prognosis of gastric cancer.
Research objectives
To investigate the three major lifestyle factors mentioned above - BMI, alcohol drinking, and smoking - and to clarify the association between these factors and the overall survival of patients with gastric cancer.
Research methods
Patients with gastric cancer were identified from the China National Cancer Center Gastric Cancer Database 1998-2018. Survival analysis was performed via Kaplan-Meier estimates and Cox proportional hazards models.
Research results
Patients who were overweight or obese were associated with a positive smoking and drinking history (P = 0.002 and P < 0.001, respectively). Current smokers were more likely to be current alcohol drinkers (61.3% vs 10.1% vs 43.2% for current, never, and former smokers, respectively, P < 0.001). Multivariable analysis indicated that BMI at diagnosis had no significant effect on prognosis. In gastrectomy patients, factors independently associated with poor survival included older age (HR = 1.20, 95%CI: 1.05-1.38, P = 0.001), any weight loss (P < 0.001), smoking history of more than 30 years (HR = 1.14, 95%CI: 1.04-1.24, P = 0.004), and increasing pTNM stage (P < 0.001).
Research conclusions
Among the total patients, weight loss (both in the 0 to 10% and > 10% groups) but not BMI at diagnosis was related to survival. With regard to other factors, smoking history of more than 30 years conferred a worse prognosis only in gastrectomy patients.
Research perspectives
Factors independently associated with poor survival included older age, any weight loss, smoking history of more than 30 years, and increasing pTNM stage. Extensive efforts are needed to elucidate mechanisms targeting the complex effects of lifestyle factors.
