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
Processing time: 106 Days and 22.1 Hours
ARTICLE HIGHLIGHTS
Research background

Some studies showed that high body mass index (BMI) was related to unfavorable prognosis of gastric cancer, while other literature revealed low preoperative BMI was related to unfavorable prognosis of gastric cancer. To our knowledge, there are still discrepancies in the relationship between BMI and prognosis of gastric cancer.

Research motivation

Considering the controversy mentioned above, our study aimed to clarify the relationship between preoperative BMI and long-term prognosis among patients with resectable gastric cancer.

Research objectives

The aim of this study was to clarify the relationship between BMI and long-term prognosis of resectable gastric cancer patients. Clinicopathological characteristics and survival were analyzed in our study. Then, multivariate analysis was used to identify risk factors. Our findings 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.

Research methods

This is a retrospective study. 2526 patients who had undergone radical gastrectomy for gastric cancer at the Cancer Hospital of the Chinese Academy of Medical Sciences were eligible and finally included in the study. Medical records were reviewed with regard to sex, age, preoperative weight loss (%), preoperative BMI, diabetes, tumor location, Borrmann classification, histological type, perineural invasion, lymphova-scular invasion, pathological tumor-node-metastasis stage, examined lymph nodes, metastatic lymph nodes, major complications (Clavien-Dindo classification of ≥ III), and follow-up data. Cumulative survival rates were obtained using the Kaplan–Meier method and compared using the log-rank test to evaluate statistically significant differences. Cox proportional hazards regression analysis was used to evaluate risk factors for poor overall survival.

Research 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 lower in the low BMI group. Relative to a normal BMI value, low BMI was associated with poor survival.

Research conclusions

Low BMI resectable gastric cancer patients have an unfavorable long-term outcome. Low BMI is an independent predictor of poor long-term prognosis. Disputed conclusions in previous literature regarding the relationship between BMI and long-term prognosis for resectable gastric cancer may be attributed to different cut-off values for BMI group division.

Research perspectives

Low BMI independently predicted poor survival among patients with resectable gastric cancer. Thus, additional treatment strategies should be undertaken in the management of gastric cancer patients with a low preoperative BMI.