Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2021; 13(3): 161-173
Published online Mar 15, 2021. doi: 10.4251/wjgo.v13.i3.161
Low body mass index is an independent predictor of poor long-term prognosis among patients with resectable gastric cancer
Shuai Ma, Hao Liu, Fu-Hai Ma, Yang Li, Peng Jin, Hai-Tao Hu, Wen-Zhe Kang, Wei-Kun Li, Jian-Ping Xiong, Yan-Tao Tian
Shuai Ma, Hao Liu, Fu-Hai Ma, Yang Li, Peng Jin, Hai-Tao Hu, Wen-Zhe Kang, Wei-Kun Li, Jian-Ping Xiong, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Tian YT performed study conception and design; Ma S, Liu H, Ma FH, Li Y, Jin P, Hu HT, Kang WZ, Li WK and Xiong JP performed acquisition of data; Ma S and Tian YT performed analysis and interpretation of data; Ma S performed drafting of the manuscript; Ma S, Liu H, Ma FH and Tian YT performed critical revision; Tian YT provided final approval.
Supported by Capital’s Funds for Health Improvement and Research, No. CFH: 2018-2-4022.
Institutional review board statement: This study was approved by the Institutional Review Board of the National Cancer Center Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
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: Yan-Tao Tian, MD, PhD, Professor, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. tianyantao@cicams.ac.cn
Received: November 22, 2020
Peer-review started: November 22, 2020
First decision: December 17, 2020
Revised: December 31, 2020
Accepted: February 4, 2021
Article in press: February 4, 2021
Published online: March 15, 2021
Abstract
BACKGROUND

The association between body mass index (BMI) and clinical outcomes remains unclear among patients with resectable gastric cancer.

AIM

To investigate the relationship between BMI and long-term survival of gastric cancer patients.

METHODS

This retrospective study included 2526 patients who underwent radical gastrectomy for gastric cancer between September 2013 and June 2018. The patients were divided into four groups: Group A (low BMI, < 18.5 kg/m2), group B (normal BMI, 18.5-24.9 kg/m2), group C (overweight, 25-29.9 kg/m2), and group D (obese, ≥ 30 kg/m2). Clinicopathological findings and survival outcomes were recorded and analyzed.

RESULTS

Preoperative weight loss was more common in the low-BMI group, while diabetes was more common in the obese group. Upper-third gastric cancer accounted for a large proportion of cases in the higher BMI groups. Major perioperative complications tended to increase with BMI. The 5-year overall survival rates were 66.4% for group A, 75.0% for group B, 77.1% for group C, and 78.6% for group D. The 5-year overall survival rate was significantly lower in group A than in group C (P = 0.008) or group D (P = 0.031). Relative to a normal BMI value, a BMI of < 18.5 kg/m2 was associated with poor survival (hazard ratio: 1.558, 95% confidence interval: 1.125-2.158, P = 0.008).

CONCLUSION

Low BMI, but not high BMI, independently predicted poor survival in patients with resectable gastric cancer.

Keywords: Gastric cancer, Malnutrition, Obesity, Body mass index, Survival benefit

Core Tip: The association between body mass index (BMI) and clinical outcomes remains unclear among patients with resectable gastric cancer. The findings of this study suggest that low BMI may result in unfavorable long-term outcomes among patients with resectable gastric cancer. The factor associated with poor overall survival based on multivariate analysis was low BMI, rather than high BMI.