Low body mass index is an independent predictor of poor long-term prognosis among patients with resectable gastric cancer

doi:10.4251/wjgo.v13.i3.161

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World Journal of Gastrointestinal Oncology

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Retrospective Study

World J Gastrointest Oncol. Mar 15, 2021; 13(3): 161-173
Published online Mar 15, 2021. doi: 10.4251/wjgo.v13.i3.161

Table 1 Patient characteristics and clinicopathological findings

	Group A (< 18.5 kg/m²)	Group B (18.5-24.9 kg/m²)	Group C (25-29.9 kg/m²)	Group D (≥ 30 kg/m²)	P value
Male sex, n (%)	73 (61.3)	1124 (77.1)	713 (85.1)	84 (75.0)	< 0.001
Age < 65 yr, n (%)	79 (66.4)	1067 (73.2)	615 (73.4)	79 (70.5)	0.384
Preoperative weight loss, n (%)					< 0.001
0% or increased	75 (63.0)	1010 (63.9)	623 (74.3)	89 (79.5)
0-5%	7 (5.9)	127 (8.7)	88 (10.5)	10 (8.9)
> 5%	37 (31.1)	320 (22.0)	127 (15.2)	13 (11.6)
BMI, median (range)	17.1 (14.0-18.4)	22.5 (18.5-24.9)	26.7 (25.0-29.9)	31.2 (30.0-48.8)	< 0.001
Diabetes, n (%)	3 (2.5)	100 (6.9)	107 (12.8)	22 (19.6)	< 0.001
Tumor location					0.044
Upper	41 (34.5)	481 (33.0)	337 (40.2)	46 (41.1)
Middle	24 (20.2)	294 (20.2)	164 (19.6)	24 (21.4)
Lower	49 (41.2)	604 (41.5)	308 (36.8)	38 (33.9)
Entire	5 (4.2)	78 (5.4)	29 (3.5)	4 (3.6)
Tumor diameter ≤ 5 cm, n (%)	857 (71.4)	1019 (69.9)	603 (72.0)	83 (74.1)	0.642
Borrmann type, n (%)					0.116
EGC	26 (21.8)	298 (20.5)	181 (21.6)	30 (26.8)
I	8 (6.7)	112 (7.7)	55 (6.6)	13 (11.6)
II	30 (25.2)	376 (25.8)	247 (29.5)	29 (25.9)
III	53 (44.5)	582 (39.9)	317 (37.8)	34 (30.4)
IV	2 (1.7)	89 (6.1)	38 (4.5)	6 (5.4)
Histological type, n (%)					0.931
Differentiated	31 (26.1)	351 (24.1)	201 (24.0)	25 (22.3)
Undifferentiated	88 (73.9)	1106 (75.9)	637 (76.0)	87 (77.7)
PNI, n (%)	48 (40.3)	701 (48.1)	419 (50.0)	49 (43.8)	0.177
LVI, n (%)	41 (34.5)	583 (40.0)	322 (38.4)	55 (49.1)	0.105
pT status, n (%)					0.606
1a	13 (10.9)	164 (11.3)	78 (9.3)	12 (10.7)
1b	16 (13.4)	216 (14.8)	131 (15.6)	21 (18.8)
2	18 (15.1)	202 (13.9)	119 (14.2)	18 (16.1)
3	38 (31.9)	434 (29.8)	280 (33.4)	34 (30.4)
4a	29 (24.4)	401 (27.5)	198 (23.6)	23 (20.5)
4b	5 (4.2)	40 (2.7)	32 (3.8)	4 (3.6)
pN status, n (%)					0.143
0	50 (42.0)	593 (40.7)	344 (41.1)	45 (40.2)
1	22 (18.5)	276 (18.9)	163 (19.5)	18 (16.1)
2	18 (15.1)	238 (16.3)	137 (16.3)	27 (24.1)
3a	21 (17.6)	169 (11.6)	116 (13.8)	13 (11.6)
3b	8 (6.7)	181 (12.4)	78 (9.3)	9 (8.0)
pTNM stage, n (%)					0.261
IA	24 (20.2)	307 (21.1)	173 (20.6)	29 (25.9)
IB	10 (8.4)	156 (10.7)	88 (10.5)	9 (8.0)
IIA	17 (14.3)	185 (12.7)	99 (11.8)	15 (13.4)
IIB	19 (16.0)	202 (13.9)	127 (15.2)	14 (12.5)
IIIA	20 (16.8)	253 (17.4)	154 (18.4)	21 (18.8)
IIIB	22 (18.5)	173 (11.9)	124 (14.8)	15 (13.4)
IIIC	7 (5.9)	181 (12.4)	73 (8.7)	9 (8.0)
eLNs, median (range)	30 (7-65)	30 (3-119)	28 (5-89)	27 (4-71)	0.008
mLN, median (range)	1 (0-24)	1 (0-67)	1 (0-48)	2 (0-29)	0.824
Major complications, n (%)	11 (9.2)	200 (13.7)	117 (14.0)	28 (25.0)	0.004

Statistically significant results are shown in bold font. BMI: Body mass index; EGC: Epigallocatechin; PNI: Perineural invasion; LVI: Lymphovascular invasion; eLNs: Examined lymph nodes; mLN: Metastatic lymph nodes; pTNM: Pathological tumor-node-metastasis.

Table 2 Paired log-rank test in all pathological tumor-node-metastasis stages/pathological tumor-node-metastasis stage I/pathological tumor-node-metastasis stage II/pathological tumor-node-metastasis stage III

	B	C	D
A	0.054/0.497/0.030/0.074	0.008/0.485/0.023/0.006	0.031/0.952/0.136/0.070
B		0.143/0.870/0.593/0.081	0.246/0.426/0.750/0.428
C			0.605/0.414/0.886/0.964

Statistically significant results are shown in bold font.

Table 3 Cox proportional hazard regression model for overall survival

	Univariate		Multivariate¹
	HR (95%CI)	P value	HR (95%CI)	P value
Sex
Male	Ref		Ref
Female	0.897 (0.742-1.085)	0.263	0.970 (0.798-1.180)	0.763
Age
< 65 yr	Ref		Ref
≥ 65 yr	1.362 (1.162-1.598)	< 0.001	1.161 (0.985-1.367)	0.075
Preoperative weight loss
0% or increased	Ref		Ref
0%–5%	1.210 (0.934-1.568)	0.148	0.964 (0.740-1.256)	0.786
> 5%	1.612 (1.355-1.918)	< 0.001	1.122 (0.937-1.342)	0.210
BMI
18.5-24.9 kg/m²	Ref		Ref
25-29.9 kg/m²	0.883 (0.747-1.043)	0.143	0.885 (0.746-1.049)	0.160
≥ 30 kg/m²	0.792 (0.533-1.177)	0.249	0.824 (0.551-1.230)	0.343
< 18.5 kg/m²	1.368 (0.996-1.880)	0.053	1.558 (1.125-2.158)	0.008
Tumor location
Lower	Ref		Ref
Middle	1.049 (0.828-1.328)	0.692	1.098 (0.863-1.395)	0.447
Upper	1.886 (1.579-2.253)	< 0.001	1.409 (1.155-1.717)	0.001
Entire	3.512 (2.639-4.674)	< 0.001	1.748 (1.292-2.366)	< 0.001
Tumor diameter
≤ 5 cm	Ref		Ref
> 5 cm	2.488 (2.141-2.892)	< 0.001	1.256 (1.068-1.477)	0.006
Borrmann type
EGC	Ref		Ref
I	4.861 (3.082-7.666)	< 0.001	1.206 (0.659-2.208)	0.544
II	4.374 (2.971-6.440)	< 0.001	1.205 (0.685-2.120)	0.518
III	8.817 (6.114-12.717)	< 0.001	1.587 (0.905-2.784)	0.107
IV	14.778 (9.703-22.510)	< 0.001	1.967 (1.070-3.613)	0.029
Histological type
Differentiated	Ref		Ref
Undifferentiated	1.495 (1.237-1.806)	< 0.001	0.891 (0.724-10.96)	0.275
PNI
No	Ref		Ref
Yes	2.785 (2.390-3.246)	< 0.001	1.064 (0.886-1.278)	0.507
LVI
No	Ref		Ref
Yes	2.764 (2.355-3.243)	< 0.001	1.231 (1.039-1.457)	0.016
pT status
1a	Ref		Ref
1b	1.596 (0.778-3.274)	0.202	1.343 (0.652-2.765)	0.424
2	3.338 (1.727-6.454)	< 0.001	1.607 (0.749-3.451)	0.223
3	9.302 (5.086-17.012)	< 0.001	2.519 (1.201-5.284)	0.014
4a	17.766 (9.732-32.433)	< 0.001	3.898 (1.844-8.239)	< 0.001
4b	18.263 (9.415-35.427)	< 0.001	3.950 (1.778-8.775)	< 0.001
pN status
0	Ref		Ref
1	3.055 (2.316-4.030)	< 0.001	1.787 (1.314-2.394)	< 0.001
2	4.849 (3.717-6.326)	< 0.001	2.544 (1.898-3.411)	< 0.001
3a	9.325 (7.207-12.066)	< 0.001	4.095 (3.042-5.512)	< 0.001
3b	11.071 (8.540-14.352)	< 0.001	4.345 (3.182-5.932)	< 0.001
eLNs
≥ 30	Ref		Ref
16–29	1.055 (0.901-1.236)	0.505	1.282 (1.083-1.518)	0.004
< 16	0.944 (0.724-1.232)	0.672	1.515 (1.139-2.015)	0.004

¹Adjusted for all variables shown in the table.

Statistically significant results are shown in bold font. HR: Hazard ratio; Ref: Reference (hazard ratio = 1.0); BMI: Body mass index; PNI: Perineural invasion; LVI: Lymphovascular invasion; eLNs: Examined lymph nodes; EGC: Epigallocatechin.

Citation: Ma S, Liu H, Ma FH, Li Y, Jin P, Hu HT, Kang WZ, Li WK, Xiong JP, Tian YT. Low body mass index is an independent predictor of poor long-term prognosis among patients with resectable gastric cancer. World J Gastrointest Oncol 2021; 13(3): 161-173
URL: https://www.wjgnet.com/1948-5204/full/v13/i3/161.htm
DOI: https://dx.doi.org/10.4251/wjgo.v13.i3.161