The impact of preoperative weight loss for gastric cancer patients after gastrectomy / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To elucidate the prognostic influence of preoperative weight loss for gastric cancer.</p><p><b>METHODS</b>A total of 672 gastric cancer patients who underwent gastrectomy between January 2003 and December 2007 were enrolled. The patients were categorized into three groups according to the percentage of weight loss before surgery no weight loss group (0%), limited group ( < 10%), and severe group ( ≥ 10%). Compared the clinicopathologic characteristics and analyzed the prognostic influence of preoperative weight loss. The survival was analyzed by Kaplan-Meier survival cure and the prognostic factors were analyzed univariately and multivariately by Cox comparative hazard modal.</p><p><b>RESULTS</b>Among the 672 cases gastric cancer, no weight loss group had 275 cases, limited group 294 cases, severe group 103 cases. Tumor size (F = 4.386) , tumor location (χ² = 15.864), depth of invasion (χ² = 22.245) , the number of lymph node metastasis (χ² = 23.803), Surgical approach (χ² = 18.423) , extent of lymphadenectomy (χ² = 8.172) , curability (χ² = 15.650) were discrepant among the three groups (all P < 0.05) . The 5-year survival rate of the patients with severe group was 28.0%, limited group was 37.7%, while the no weight loss group was 40.3% (χ² = 20.148, P < 0.05). Age (95% CI 0.480 - 0.744, P = 0.000), weight loss before surgery (95% CI 0.371 - 0.687, P = 0.000), depth invasion (95% CI 0.289 - 0.564, P = 0.000), lymph node metastasis (95% CI 0.451 - 0.783, P = 0.000), extent of lymphadenectomy (95% CI 0.647 - 0.990, P = 0.000), curability (95% CI 0.291 - 0.486, P = 0.000), postoperative adjuvant chemotherapy (95% CI 0.511 - 0.846, P = 0.000) were associated with survival of this group. In multivariate analysis, age (HR = 1.618, 95% CI 1.298 - 2.016, P = 0.000), weight loss before surgery (HR = 1.258, 95%CI 1.077 - 1.469, P = 0.004), depth of invasion (HR = 1.810, 95% CI 1.287 - 2.545, P = 0.000), N stage (HR = 1.555, 95% CI 1.413 - 1.172, P = 0.000) were independent prognostic factors for survival.</p><p><b>CONCLUSIONS</b>Patients with weight loss above 10% have poor prognosis. Weight loss before surgery may be an important independent prognostic factor for gastric cancer.</p>