Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Clinical Research Promotion Unit, Shizuoka Cancer Center, Shizuoka, Japan.
Ann Surg Oncol. 2018 Apr;25(4):974-983. doi: 10.1245/s10434-018-6342-8. Epub 2018 Jan 31.
Preoperative malnutrition can worsen morbidity and mortality; however, the role of postgastrectomy nutritional status remains unclear. Our purpose was to clarify whether malnutrition after gastrectomy could predict long-term survival.
Patients with pathological stage I, II, and III gastric cancer who underwent gastrectomy between 2002 and 2013 were included. The nutrition risk index (NRI) was evaluated before and at 1, 3, 6 and 12 months after gastrectomy. The patients were divided into normal (NRI > 97.5) or malnutrition (NRI ≤ 97.5) groups, and we compared the correlations of clinicopathological characteristics, surgical treatment, and overall survival between the two groups.
Among the 760 participants, patients in the malnutrition group were significantly older and had higher incidences of comorbidity and advanced cancer than the patients in the normal group. Multivariate analysis showed that overall survival was poorer in the malnutrition group before gastrectomy [hazard ratio (HR) 1.68] and at 1 month (HR 1.77), 3 months (HR 2.18), 6 months (HR 1.81) and 12 months (HR 2.17) after gastrectomy (all p < 0.01). Malnutrition at 1 and 3 months after gastrectomy was significantly associated with poor cause-specific survival. Total gastrectomy, preoperative malnutrition, older age, and adjuvant chemotherapy were independent risk factors of postoperative malnutrition at 12 months postgastrectomy.
Malnutrition before gastrectomy and at 1, 3, 6 and 12 months after gastrectomy significantly and adversely affects overall survival. Nutritional interventions to lessen the impact of postoperative malnutrition offer hope for prolonged survival.
术前营养不良可导致发病率和死亡率升高；然而，胃切除术后的营养状况的作用仍不清楚。我们的目的是阐明胃切除术后的营养不良是否可以预测长期生存。
纳入 2002 年至 2013 年间接受胃切除术的病理分期 I、II 和 III 期胃癌患者。在胃切除术前和术后 1、3、6 和 12 个月评估营养风险指数（NRI）。将患者分为正常（NRI＞97.5）或营养不良（NRI≤97.5）组，并比较两组之间的临床病理特征、手术治疗和总体生存的相关性。
在 760 名参与者中，营养不良组患者的年龄明显更大，且合并症和晚期癌症的发生率更高。多因素分析显示，在胃切除术前[风险比（HR）1.68]和术后 1 个月（HR 1.77）、3 个月（HR 2.18）、6 个月（HR 1.81）和 12 个月（HR 2.17）时，营养不良组的总体生存率更差（均 p＜0.01）。胃切除术后 1 个月和 3 个月的营养不良与不良的癌症特异性生存率显著相关。全胃切除术、术前营养不良、年龄较大和辅助化疗是胃切除术后 12 个月发生术后营养不良的独立危险因素。
胃切除术前和术后 1、3、6 和 12 个月的营养不良显著且不利地影响总体生存率。营养干预以减轻术后营养不良的影响有望延长生存时间。
