Abstract 1399P
Background
The standard therapy for locally advanced gastric cancer (GC) is a combination of radical gastrectomy and pre- and/or post-operative chemotherapy. Gastrectomy sometimes induces severe body weight loss (BWL) which has been reported as a risk factor for incompliance with an adjuvant chemotherapy. However, there are no reports describing the risk factors for postoperative BWL using data from a prospective clinical trial. The phase III trial (JCOG1001), comparing bursectomy and non-bursectomy in resectable advanced GC treatment, registered a total of 1204 patients between June 2010 and March 2015. Using the patients in this trial where feeding jejunostomy was seldom applied, we investigated the risk factors for BWL after gastrectomy.
Methods
Of 1204 registered patients, 728 were included in this post-hoc analysis after excluding 244 diagnosed with pathological stage I, IV, or unavailable staging data, and 232 without data of postoperative body weight. The percentage of BWL (%BWL) was defined as the percentile of decrease in the body weight immediately before adjuvant chemotherapy initiation from the body weight before surgery. Background, surgery, and postoperative data were compared between patients with and without %BWL≥10. The risk factors for %BWL≥10 were examined by the Logistic regression analysis.
Results
Male sex, preoperative BMI≥25, high preoperative C-reactive protein levels, total gastrectomy, Roux-en-Y reconstruction, long operation time, excessive blood loss, and postoperative complications were seen more frequently in patients with %BWL≥10 than the others. Preoperative BMI of ≥25 (vs. <25) (odds ratio [OR] 1.881, 95% confidence interval [CI] 1.272-2.781, P=0.0016), total gastrectomy (vs. distal) (OR 3.303, 95% CI 2.232-4.889, P<0.0001), and grade 2-4 postoperative complications (vs. grade 0-1) (OR 3.288, 95% CI 2.225-4.857, P<0.0001) were risk factors for %BWL≥10 identified by multivariable analysis.
Conclusions
For patients who had high preoperative BMI, received total gastrectomy, and/or developed postoperative complications, nutritional support may be required to prevent excessive body weight loss especially when planning adjuvant chemotherapy.
Clinical trial identification
UMIN000003688.
Editorial acknowledgement
Legal entity responsible for the study
Japan clinical oncology group.
Funding
The Japan Agency for Medical Research and Development under grant number JP16ck0106048, the Ministry of Health, Labour, and Welfare of Japan (H20-045), and the National Cancer Centre Research and Development Fund (23-A-16, 23-A-19, 26-A-4, 29-A-3, 2020-J-3).
Disclosure
All authors have declared no conflicts of interest.