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

Xuechao Liu, Pengfei Xu, Haibo Qiu, Dazhi Xu, Wei Li, Youqing Zhan, Yuanfang Li, Yingbo Chen, Zhiwei Zhou, Xiaowei Sun, Xuechao Liu, Pengfei Xu, Haibo Qiu, Dazhi Xu, Wei Li, Youqing Zhan, Yuanfang Li, Yingbo Chen, Zhiwei Zhou, Xiaowei Sun

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.

Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Overall survival based on nutritional status in patients with stage I to III (A), stage I (B), stage II (C), and stage III (D) GC, respectively.
Figure 2
Figure 2
Overall survival based on nutritional status in female patients (A), male patients (B), patient

Figure 3

Overall survival based on nutritional…

Figure 3

Overall survival based on nutritional status in nonanemic patients (B), anemic patients (A),…

Figure 3
Overall survival based on nutritional status in nonanemic patients (B), anemic patients (A), patients without adjuvant chemotherapy (C), and patients with adjuvant chemotherapy (D), respectively.

Figure 4

Overall survival based on nutritional…

Figure 4

Overall survival based on nutritional status in patients with BMI ≥18.5 kg/m 2…

Figure 4
Overall survival based on nutritional status in patients with BMI ≥18.5 kg/m2 (A), preoperative weight loss <5% of body weight (B), or serum albumin ≥35 g/l (C), respectively.
Figure 3
Figure 3
Overall survival based on nutritional status in nonanemic patients (B), anemic patients (A), patients without adjuvant chemotherapy (C), and patients with adjuvant chemotherapy (D), respectively.
Figure 4
Figure 4
Overall survival based on nutritional status in patients with BMI ≥18.5 kg/m2 (A), preoperative weight loss <5% of body weight (B), or serum albumin ≥35 g/l (C), respectively.

References

    1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–E386.
    1. Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, Sydes M, Fayers P. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer. 1999;79(9–10):1522–1530.
    1. Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66(2):115–132.
    1. Rahman R, Asombang AW, Ibdah JA. Characteristics of gastric cancer in Asia. World J Gastroenterol. 2014;20(16):4483–4490.
    1. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol. 2010;17(12):3077–3079.
    1. Colotta F, Allavena P, Sica A, Garlanda C, Mantovani A. Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability. Carcinogenesis. 2009;30(7):1073–1081.
    1. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454(7203):436–444.
    1. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140(6):883–899.
    1. Choi WJ, Kim J. Nutritional care of gastric cancer patients with clinical outcomes and complications: a review. 2016;5(2):65–78.
    1. Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs. 2005;9(Suppl. 2):S51–S63.
    1. Thoresen L, Frykholm G, Lydersen S, Ulveland H, Baracos V, Prado CM, Birdsell L, Falkmer U. Nutritional status, cachexia and survival in patients with advanced colorectal carcinoma. Different assessment criteria for nutritional status provide unequal results. Clin Nutr. 2013;32(1):65–72.
    1. Lim SL, Ong KC, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012;31(3):345–350.
    1. Khan S, Alibay TA, Merad M, DiPalma M, Raynard B, Antoun S. [Detection and evaluation of malnutrition in oncology: what tools, what type of cancer and for what purposes?] Bull Cancer. 2016
    1. Gregg JR, Cookson MS, Phillips S, Salem S, Chang SS, Clark PE, Davis R, Stimson CJ, Jr, Aghazadeh M, Smith JA., Jr Effect of preoperative nutritional deficiency on mortality after radical cystectomy for bladder cancer. J Urol. 2011;185(1):90–96.
    1. Morgan TM, Tang D, Stratton KL, Barocas DA, Anderson CB, Gregg JR, Chang SS, Cookson MS, Herrell SD, Smith JA., Jr Preoperative nutritional status is an important predictor of survival in patients undergoing surgery for renal cell carcinoma. Eur Urol. 2011;59(6):923–928.
    1. Murad AM, Santiago FF, Petroianu A, Rocha PR, Rodrigues MA, Rausch M. Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer. Cancer. 1993;72(1):37–41.
    1. Paoletti X, Oba K, Burzykowski T, Michiels S, Ohashi Y, Pignon JP, Rougier P, Sakamoto J, Sargent D, Sasako M. Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA. 2010;303(17):1729–1737.
    1. Oh DY, Bang YJ. Adjuvant and neoadjuvant therapy for gastric cancer. Curr Treat Options Oncol. 2013;14(3):311–320.
    1. Rausei S, Dionigi G, Boni L. Evaluation of the Seventh American Joint Committee on Cancer/International Union Against Cancer classification of gastric adenocarcinoma in comparison with the sixth classification. Cancer. 2011;117(12):2823–2824. [author reply 4]
    1. Chen HN, Chen XZ, Zhang WH, Yang K, Chen XL, Zhang B, Chen ZX, Chen JP, Zhou ZG, Hu JK. The impact of body mass index on the surgical outcomes of patients with gastric cancer: a 10-year, single-institution cohort study. Medicine. 2015;94(42):e1769.
    1. Gustafsson UO, Ljungqvist O. Perioperative nutritional management in digestive tract surgery. Curr Opin Clin Nutr Metab Care. 2011;14(5):504–509.
    1. Hennessey DB, Burke JP, Ni-Dhonochu T, Shields C, Winter DC, Mealy K. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg. 2010;252(2):325–329.
    1. von Meyenfeldt M. Cancer-associated malnutrition: an introduction. Eur J Oncol Nurs. 2005;9(Suppl. 2):S35–S38.
    1. Lee H, Cho YS, Jung S, Kim H. Effect of nutritional risk at admission on the length of hospital stay and mortality in gastrointestinal cancer patients. Clin Nutr Res. 2013;2(1):12–18.
    1. Tian J, Chen JS. Nutritional status and quality of life of the gastric cancer patients in Changle County of China. World J Gastroenterol. 2005;11(11):1582–1586.
    1. Minami Y, Kawai M, Fujiya T, Suzuki M, Noguchi T, Yamanami H, Kakugawa Y, Nishino Y. Family history, body mass index and survival in Japanese patients with stomach cancer: a prospective study. Int J Cancer. 2015;136(2):411–424.
    1. Zeng Q, Shen LJ, Guo X, Guo XM, Qian CN, Wu PH. Critical weight loss predicts poor prognosis in nasopharyngeal carcinoma. BMC Cancer. 2016;16:169.
    1. Lien YC, Hsieh CC, YC W, Hsu HS, Hsu WH, Wang LS, Huang MH, Huang BS. Preoperative serum albumin level is a prognostic indicator for adenocarcinoma of the gastric cardia. J Gastrointest Surg. 2004;8(8):1041–1048.
    1. Ommundsen N, Wyller TB, Nesbakken A, Jordhoy MS, Bakka A, Skovlund E, Rostoft S. Frailty is an independent predictor of survival in older patients with colorectal cancer. Oncologist. 2014;19(12):1268–1275.
    1. Sakurai K, Ohira M, Tamura T, Toyokawa T, Amano R, Kubo N, Tanaka H, Muguruma K, Yashiro M, Maeda K. Predictive potential of preoperative nutritional status in long-term outcome projections for patients with gastric cancer. Ann Surg Oncol. 2016;23(2):525–533.
    1. Tokunaga R, Sakamoto Y, Nakagawa S, Miyamoto Y, Yoshida N, Oki E, Watanabe M, Baba H. Prognostic nutritional index predicts severe complications, recurrence, and poor prognosis in patients with colorectal cancer undergoing primary tumor resection. Dis Colon Rectum. 2015;58(11):1048–1057.
    1. Rosania R, Chiapponi C, Malfertheiner P, Venerito M. Nutrition in patients with gastric cancer: an update. Gastrointest Tumors. 2016;2(4):178–187.
    1. Meijerink WJ, von Meyenfeldt MF, Rouflart MM, Soeters PB. Efficacy of perioperative nutritional support. Lancet. 1992;340(8812):187–188.
    1. Gavazzi C, Colatruglio S, Valoriani F, Mazzaferro V, Sabbatini A, Biffi R, Mariani L, Miceli R. Impact of home enteral nutrition in malnourished patients with upper gastrointestinal cancer: a multicentre randomised clinical trial. Eur J Cancer. 2016;64:107–112.
    1. Bozzetti F, Braga M, Gianotti L, Gavazzi C, Mariani L. Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial. Lancet. 2001;358(9292):1487–1492.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever