Preoperative Cachexia Predicts Poor Outcomes in Young Rather Than Elderly Gastric Cancer Patients: A Prospective Study

MATERIALS AND METHODS

Patients

Data were prospectively collected from 578 patients with GC who underwent subtotal gastrectomy at the Gastrointestinal Surgical Departments of The Second Affiliated Hospital of Wenzhou Medical University and The First Affiliated Hospital of Wenzhou Medical University in China between January 2014 and December 2016. Three patients who lacked imaging data were excluded. Current study was carried out in accordance with the Declaration of Helsinki, and the study protocol was approved by the ethics committees of the Second Affiliated Hospital of Wenzhou Medical University and the First Affiliated Hospital of Wenzhou Medical University.

Diagnosis of cancer cachexia

The definition of cachexia was >5% loss of stable body weight over the previous 6 months, a body mass index (BMI) <20 kg/m2 and ongoing weight loss >2%, or sarcopenia and ongoing weight loss >2%.¹ Specifically, low muscle mass was defined as a skeletal muscle mass index of <7 kg/m2 for men and <5.7 kg/m2 for women.⁶ Muscle mass was assessed using multifrequency bioelectrical impedance with eight tactile electrodes (InBody 430; Inbody Japan, Tokyo, Japan).

Statistical analysis

The Kolmogorov–Smirnov test was performed to assess the distribution equality of continuous parameters. Normally distributed data are presented as means ± standard deviations (SDs), and non-normally distributed data are presented as medians and interquartile ranges (IQRs). In univariate analyses, the independent t-test and Mann–Whitney U-test were used to analyze intergroup differences in continuous variables, and the chi-square test and Fisher’s exact test were applied to categorical variables. Overall survival (OS) was defined as the time between the date of diagnosis and the date of death or last known follow-up. The Kaplan–Meier method and log-rank test were used to estimate and compare survival based on specific factors. The Cox proportional hazard model was used to estimate the risk ratio in univariate and multivariate analyses. All P-values were two-sided, and P<0.05 was considered statistically significant. All statistical analyses were performed using SPSS software (version 22.0; SPSS Inc., Chicago, IL, USA).

RESULTS

Patient characteristics

A total of 575 patients were enrolled in the present study. The baseline characteristics of these patients are shown in Table 1. Most patients were men (n=433, 75.3%), and the mean age of all the patients was 64.41 years (SD =10.6). The median BMI was 22.21 kg/m2 (IQR =20.20–24.22). The mean PLR (platelet/lymphocyte ratio) and NLR (neutrophil/lymphocyte ratio) were 169.87 (SD =10.6) and 2.71 (SD =2.0), respectively. Of the 575 patients analyzed, 206 (35.8%) were diagnosed with cancer cachexia.

(To view a larger version of Table 1, click here.)

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