Guo Yinning, Chen Yimeng, Miao Xueyi, Hu Jieman, Zhao Kang, Ding Lingyu, Chen Li, Xu Ting, Jiang Xiaoman, Zhu Hanfei, Xu Xinyi, Xu Qin
School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China.
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, China.
J Cancer Surviv. 2025 Apr;19(2):468-478. doi: 10.1007/s11764-023-01480-4. Epub 2023 Oct 21.
Elderly gastric cancer patients undergoing radical gastrectomy are prone to experience unexpected weight loss. Preoperative weight risk prediction may be a promising way to prevent weight loss and improve prognosis. The objectives of this study were to explore the BMI trajectory of elderly gastric cancer patients one year after surgery, evaluate theirs the association with outcomes, and explore their related predictors, so as to provide evidence for weight management and prognosis improvement.
412 gastric cancer patients were included and recorded BMI at 6 time points. The trajectories of BMI were analyzed by growth mixture modeling, and the associations of BMI trajectories with outcomes as well as their predictors were investigated by regression models.
We identified 3 classes of BMI trajectories: the "slow-decreasing BMI", "rapid-decreasing BMI" and "maintaining BMI". Compared with class1, patients in class 2 were more likely to have a higher frequency of readmission within 1-year(β = 0.59, 95%CI: 0.29, 0.89, P < 0.001) and a higher rate of mortality within 1-year(β = 24.74, 95%CI: 9.60, 63.74, P < 0.001) ; patients in class 3 were more likely to have a higher quality of life (β=-10.46, 95%CI: -17.70, -3.22, P = 0.005) and fewer readmission times within one year (β=-0.43, 95%CI: -0.77, -0.09, P = 0.015). Predictors of decreasing BMI trajectories were TNM stage, comorbidity, anxiety, family cohesion and social support(P < 0.05).
Our findings can provide a basis for screening high-risk elderly gastric cancer patients with poor prognosis, implementing risk stratification, formulating accurate weight management programs and improving prognosis.
The results of our study can provide gastric cancer survivors with preoperative risk screening based on predictive factors so that nutritional support and weight management can be implemented in a timely manner to improve prognosis.
接受根治性胃切除术的老年胃癌患者容易出现意外体重减轻。术前体重风险预测可能是预防体重减轻和改善预后的一种有前景的方法。本研究的目的是探讨老年胃癌患者术后一年的BMI轨迹，评估其与结局的关联，并探索其相关预测因素，以便为体重管理和改善预后提供证据。
纳入412例胃癌患者，并在6个时间点记录BMI。通过生长混合模型分析BMI轨迹，并通过回归模型研究BMI轨迹与结局及其预测因素的关联。
我们确定了3类BMI轨迹：“缓慢下降的BMI”、“快速下降的BMI”和“维持BMI”。与第1类相比，第2类患者在1年内再次入院的频率更高（β = 0.59，95%CI：0.29，0.89，P < 0.001），1年内死亡率更高（β = 24.74，95%CI：9.60，63.74，P < 0.001）；第3类患者更有可能具有更高的生活质量（β = -10.46，95%CI：-17.70，-3.22，P = 0.005），且1年内再次入院次数更少（β = -0.43，95%CI：-0.77，-0.09，P = 0.015）。BMI轨迹下降的预测因素为TNM分期、合并症、焦虑、家庭凝聚力和社会支持（P < 0.05）。
我们的研究结果可为筛查预后不良的高危老年胃癌患者、实施风险分层、制定准确的体重管理方案和改善预后提供依据。
我们的研究结果可为胃癌幸存者提供基于预测因素的术前风险筛查，以便及时实施营养支持和体重管理以改善预后。
