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Erschienen in: Gastric Cancer 3/2016

01.07.2016 | Original Article

Impact of being underweight on the long-term outcomes of patients with gastric cancer

verfasst von: Kazuhiro Migita, Tomoyoshi Takayama, Sohei Matsumoto, Kohei Wakatsuki, Tetsuya Tanaka, Masahiro Ito, Tomohiro Kunishige, Hiroshi Nakade, Yoshiyuki Nakajima

Erschienen in: Gastric Cancer | Ausgabe 3/2016

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Abstract

Background

The aim of this study was to investigate the impact of being underweight on the long-term outcomes of gastric cancer patients.

Methods

This study reviewed the medical records of 638 patients with gastric cancer who underwent gastrectomy between January 2003 and December 2011. The patients were divided into three groups according to the WHO classification: underweight (BMI <18.5 kg/m2), normal weight (BMI ≥18.5 and <25 kg/m2), and overweight (BMI ≥25 kg/m2). A multivariate analysis was performed to identify prognostic factors.

Results

The mean BMI immediately before surgery was 22.5 kg/m2 (standard deviation, 3.3 kg/m2). According to the BMI subgroup, 73 patients (11.4 %) were underweight, 431 patients (67.6 %) were of normal weight, and 134 patients (21 %) were overweight. The 5-year overall survival (OS) rate was 66.6 % in the underweight patients, 81.3 % in the normal weight patients, and 79.9 % in the overweight patients (P = 0.001). The OS rate was significantly lower in the underweight patients than in the normal weight and overweight patients among those with stage I disease, and it was also lower than in the normal weight patients among those with stage II and III disease. In the multivariate analysis, being underweight was found to be an independent predictor of OS, but it was not an independent predictor among patients with stage II and III disease.

Conclusions

Being underweight is a simple and reliable predictor of a worse long-term outcome among gastric cancer patients. Being underweight is considered to be associated with a higher risk of non-cancer death.
Literatur
1.
Zurück zum Zitat 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;252:325–9.CrossRefPubMed 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;252:325–9.CrossRefPubMed
2.
Zurück zum Zitat Schwegler I, von Holzen A, Gutzwiller JP, Schlumpf R, Muhlebach S, Stanga Z. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg. 2010;97:92–7.CrossRefPubMed Schwegler I, von Holzen A, Gutzwiller JP, Schlumpf R, Muhlebach S, Stanga Z. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg. 2010;97:92–7.CrossRefPubMed
3.
Zurück zum Zitat Migita K, Takayama T, Saeki K, Matsumoto S, Wakatsuki K, Enomoto K, et al. The prognostic nutritional index predicts long-term outcomes of gastric cancer patients independent of tumor stage. Ann Surg Oncol. 2013;20:2647–54.CrossRefPubMed Migita K, Takayama T, Saeki K, Matsumoto S, Wakatsuki K, Enomoto K, et al. The prognostic nutritional index predicts long-term outcomes of gastric cancer patients independent of tumor stage. Ann Surg Oncol. 2013;20:2647–54.CrossRefPubMed
4.
Zurück zum Zitat Lien YC, Hsieh CC, Wu YC, Hsu HS, Hsu WH, Wang LS, et al. Preoperative serum albumin level is a prognostic indicator for adenocarcinoma of the gastric cardia. J Gastrointest Surg. 2004;8:1041–8.CrossRefPubMed Lien YC, Hsieh CC, Wu YC, Hsu HS, Hsu WH, Wang LS, et al. Preoperative serum albumin level is a prognostic indicator for adenocarcinoma of the gastric cardia. J Gastrointest Surg. 2004;8:1041–8.CrossRefPubMed
5.
Zurück zum Zitat Dhar DK, Kubota H, Tachibana M, Kotoh T, Tabara H, Masunaga R, et al. Body mass index determines the success of lymph node dissection and predicts the outcome of gastric carcinoma patients. Oncology. 2000;59:18–23.CrossRefPubMed Dhar DK, Kubota H, Tachibana M, Kotoh T, Tabara H, Masunaga R, et al. Body mass index determines the success of lymph node dissection and predicts the outcome of gastric carcinoma patients. Oncology. 2000;59:18–23.CrossRefPubMed
6.
Zurück zum Zitat Barry JD, Blackshaw GR, Edwards P, Lewis WG, Murphy P, Hodzovic I, et al. Western body mass indices need not compromise outcomes after modified D2 gastrectomy for carcinoma. Gastric Cancer. 2003;6:80–5.PubMed Barry JD, Blackshaw GR, Edwards P, Lewis WG, Murphy P, Hodzovic I, et al. Western body mass indices need not compromise outcomes after modified D2 gastrectomy for carcinoma. Gastric Cancer. 2003;6:80–5.PubMed
7.
Zurück zum Zitat Bickenbach KA, Denton B, Gonen M, Brennan MF, Coit DG, Strong VE. Impact of obesity on perioperative complications and long-term survival of patients with gastric cancer. Ann Surg Oncol. 2013;20:780–7.CrossRefPubMed Bickenbach KA, Denton B, Gonen M, Brennan MF, Coit DG, Strong VE. Impact of obesity on perioperative complications and long-term survival of patients with gastric cancer. Ann Surg Oncol. 2013;20:780–7.CrossRefPubMed
8.
Zurück zum Zitat Tokunaga M, Hiki N, Fukunaga T, Ohyama S, Yamaguchi T, Nakajima T. Better 5-year survival rate following curative gastrectomy in overweight patients. Ann Surg Oncol. 2009;16:3245–51.CrossRefPubMed Tokunaga M, Hiki N, Fukunaga T, Ohyama S, Yamaguchi T, Nakajima T. Better 5-year survival rate following curative gastrectomy in overweight patients. Ann Surg Oncol. 2009;16:3245–51.CrossRefPubMed
9.
Zurück zum Zitat Kong F, Li H, Fan Y, Zhang X, Cao S, Yu J, et al. Overweight patients achieve ideal body weight following curative gastrectomy resulting in better long-term prognosis. Obes Surg. 2013;23:650–6.CrossRefPubMed Kong F, Li H, Fan Y, Zhang X, Cao S, Yu J, et al. Overweight patients achieve ideal body weight following curative gastrectomy resulting in better long-term prognosis. Obes Surg. 2013;23:650–6.CrossRefPubMed
10.
Zurück zum Zitat Sinicrope FA, Foster NR, Yothers G, Benson A, Seitz JF, Labianca R, et al. Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy. Cancer (Phila). 2013;119:1528–36.CrossRef Sinicrope FA, Foster NR, Yothers G, Benson A, Seitz JF, Labianca R, et al. Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy. Cancer (Phila). 2013;119:1528–36.CrossRef
11.
Zurück zum Zitat Ishizuka M, Kubota K, Kita J, Shimoda M, Kato M, Sawada T. Underweight patients show an increased rate of postoperative death after surgery for hepatocellular carcinoma. J Surg Oncol. 2011;104:809–13.CrossRefPubMed Ishizuka M, Kubota K, Kita J, Shimoda M, Kato M, Sawada T. Underweight patients show an increased rate of postoperative death after surgery for hepatocellular carcinoma. J Surg Oncol. 2011;104:809–13.CrossRefPubMed
12.
Zurück zum Zitat Huang PY, Wang CT, Cao KJ, Guo X, Guo L, Mo HY, et al. Pretreatment body mass index as an independent prognostic factor in patients with locoregionally advanced nasopharyngeal carcinoma treated with chemoradiotherapy: findings from a randomised trial. Eur J Cancer. 2013;49:1923–31.CrossRefPubMed Huang PY, Wang CT, Cao KJ, Guo X, Guo L, Mo HY, et al. Pretreatment body mass index as an independent prognostic factor in patients with locoregionally advanced nasopharyngeal carcinoma treated with chemoradiotherapy: findings from a randomised trial. Eur J Cancer. 2013;49:1923–31.CrossRefPubMed
13.
Zurück zum Zitat Dignam JJ, Wieand K, Johnson KA, Fisher B, Xu L, Mamounas EP. Obesity, tamoxifen use, and outcomes in women with estrogen receptor-positive early-stage breast cancer. J Natl Cancer Inst. 2003;95:1467–76.CrossRefPubMedPubMedCentral Dignam JJ, Wieand K, Johnson KA, Fisher B, Xu L, Mamounas EP. Obesity, tamoxifen use, and outcomes in women with estrogen receptor-positive early-stage breast cancer. J Natl Cancer Inst. 2003;95:1467–76.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Moon HG, Han W, Noh DY. Underweight and breast cancer recurrence and death: a report from the Korean Breast Cancer Society. J Clin Oncol. 2009;27:5899–905.CrossRefPubMed Moon HG, Han W, Noh DY. Underweight and breast cancer recurrence and death: a report from the Korean Breast Cancer Society. J Clin Oncol. 2009;27:5899–905.CrossRefPubMed
15.
Zurück zum Zitat Kizer NT, Thaker PH, Gao F, Zighelboim I, Powell MA, Rader JS, et al. The effects of body mass index on complications and survival outcomes in patients with cervical carcinoma undergoing curative chemoradiation therapy. Cancer (Phila). 2010;117:948–56.CrossRef Kizer NT, Thaker PH, Gao F, Zighelboim I, Powell MA, Rader JS, et al. The effects of body mass index on complications and survival outcomes in patients with cervical carcinoma undergoing curative chemoradiation therapy. Cancer (Phila). 2010;117:948–56.CrossRef
16.
Zurück zum Zitat Liu JY, Li YH, Liu ZW, Zhang ZL, Ye YL, Yao K, et al. Influence of body mass index on oncological outcomes in patients with upper urinary tract urothelial carcinoma treated with radical nephroureterectomy. Int J Urol. 2014;21:136–42.CrossRefPubMed Liu JY, Li YH, Liu ZW, Zhang ZL, Ye YL, Yao K, et al. Influence of body mass index on oncological outcomes in patients with upper urinary tract urothelial carcinoma treated with radical nephroureterectomy. Int J Urol. 2014;21:136–42.CrossRefPubMed
17.
Zurück zum Zitat Alici S, Kaya S, Izmirli M, Tuncer I, Dogan E, Ozbek H, et al. Analysis of survival factors in patients with advanced-stage gastric adenocarcinoma. Med Sci Monit. 2006;12:CR221–9.PubMed Alici S, Kaya S, Izmirli M, Tuncer I, Dogan E, Ozbek H, et al. Analysis of survival factors in patients with advanced-stage gastric adenocarcinoma. Med Sci Monit. 2006;12:CR221–9.PubMed
18.
Zurück zum Zitat WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63.CrossRef WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63.CrossRef
19.
Zurück zum Zitat Sobin L, Gospodarowicz M, Wittekind C, editors. International Union Against Cancer (UICC). TNM classification of malignant tumors. 7th ed. New York: Wiley-Blackwell; 2010. Sobin L, Gospodarowicz M, Wittekind C, editors. International Union Against Cancer (UICC). TNM classification of malignant tumors. 7th ed. New York: Wiley-Blackwell; 2010.
20.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Nakane Y, Okamura S, Akehira K, Boku T, Okusa T, Tanaka K, et al. Correlation of preoperative carcinoembryonic antigen levels and prognosis of gastric cancer patients. Cancer (Phila). 1994;73:2703–8.CrossRef Nakane Y, Okamura S, Akehira K, Boku T, Okusa T, Tanaka K, et al. Correlation of preoperative carcinoembryonic antigen levels and prognosis of gastric cancer patients. Cancer (Phila). 1994;73:2703–8.CrossRef
22.
Zurück zum Zitat Sierzega M, Kolodziejczyk P, Kulig J. Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg. 2010;97:1035–42.CrossRefPubMed Sierzega M, Kolodziejczyk P, Kulig J. Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg. 2010;97:1035–42.CrossRefPubMed
23.
Zurück zum Zitat Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980;69:491–7.CrossRefPubMed Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980;69:491–7.CrossRefPubMed
24.
Zurück zum Zitat Meyerhardt JA, Catalano PJ, Haller DG, Mayer RJ, Benson AB III, Macdonald JS, et al. Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer (Phila). 2003;98:484–95.CrossRef Meyerhardt JA, Catalano PJ, Haller DG, Mayer RJ, Benson AB III, Macdonald JS, et al. Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer (Phila). 2003;98:484–95.CrossRef
25.
Zurück zum Zitat Aoyama T, Yoshikawa T, Shirai J, Hayashi T, Yamada T, Tsuchida K, et al. Body weight loss after surgery is an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer. Ann Surg Oncol. 2013;20:2000–6.CrossRefPubMed Aoyama T, Yoshikawa T, Shirai J, Hayashi T, Yamada T, Tsuchida K, et al. Body weight loss after surgery is an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer. Ann Surg Oncol. 2013;20:2000–6.CrossRefPubMed
26.
Zurück zum Zitat Senkal M, Zumtobel V, Bauer KH, Marpe B, Wolfram G, Frei A, et al. Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: a prospective randomized study. Arch Surg. 1999;134:1309–16.CrossRefPubMed Senkal M, Zumtobel V, Bauer KH, Marpe B, Wolfram G, Frei A, et al. Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: a prospective randomized study. Arch Surg. 1999;134:1309–16.CrossRefPubMed
27.
Zurück zum Zitat Braga M, Gianotti L, Vignali A, Carlo VD. Preoperative oral arginine and n-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer. Surgery (St. Louis). 2002;132:805–14.CrossRef Braga M, Gianotti L, Vignali A, Carlo VD. Preoperative oral arginine and n-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer. Surgery (St. Louis). 2002;132:805–14.CrossRef
28.
Zurück zum Zitat Sultan J, Griffin SM, Di Franco F, Kirby JA, Shenton BK, Seal CJ, et al. Randomized clinical trial of omega-3 fatty acid-supplemented enteral nutrition versus standard enteral nutrition in patients undergoing oesophagogastric cancer surgery. Br J Surg. 2012;99:346–55.CrossRefPubMedPubMedCentral Sultan J, Griffin SM, Di Franco F, Kirby JA, Shenton BK, Seal CJ, et al. Randomized clinical trial of omega-3 fatty acid-supplemented enteral nutrition versus standard enteral nutrition in patients undergoing oesophagogastric cancer surgery. Br J Surg. 2012;99:346–55.CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Fujitani K, Tsujinaka T, Fujita J, Miyashiro I, Imamura H, Kimura Y, et al. Prospective randomized trial of preoperative enteral immunonutrition followed by elective total gastrectomy for gastric cancer. Br J Surg. 2012;99:621–9.CrossRefPubMed Fujitani K, Tsujinaka T, Fujita J, Miyashiro I, Imamura H, Kimura Y, et al. Prospective randomized trial of preoperative enteral immunonutrition followed by elective total gastrectomy for gastric cancer. Br J Surg. 2012;99:621–9.CrossRefPubMed
Metadaten
Titel
Impact of being underweight on the long-term outcomes of patients with gastric cancer
verfasst von
Kazuhiro Migita
Tomoyoshi Takayama
Sohei Matsumoto
Kohei Wakatsuki
Tetsuya Tanaka
Masahiro Ito
Tomohiro Kunishige
Hiroshi Nakade
Yoshiyuki Nakajima
Publikationsdatum
01.07.2016
Verlag
Springer Japan
Erschienen in
Gastric Cancer / Ausgabe 3/2016
Print ISSN: 1436-3291
Elektronische ISSN: 1436-3305
DOI
https://doi.org/10.1007/s10120-015-0531-y

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