Published online Apr 14, 2020. doi: 10.3748/wjg.v26.i14.1613
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
As the gastric cancer patient population grows, lifestyle factors contributing to improved or adverse survival are becoming a focus of increasing interest.
Lifestyle factors such as body mass index (BMI), alcohol drinking, and cigarette smoking, are likely to impact the prognosis of gastric cancer.
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.
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.
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).
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.
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.