Matsui Ryota, Nunobe Souya, Ri Motonari, Makuuchi Rie, Irino Tomoyuki, Hayami Masaru, Ohashi Manabu, Sano Takeshi
Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135- 8550, Japan.
Langenbecks Arch Surg. 2025 Jul 1;410(1):206. doi: 10.1007/s00423-025-03785-7.
This study aimed to clarify the effects of preoperative nutritional intervention on long-term survival after radical gastrectomy in patients with severe malnutrition.
This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary stages I-III gastric cancer between August 2010 and December 2021. The primary outcome measure was overall survival (OS). We compared OS between the groups with and without nutritional intervention. In the intervention group, we compared OS between the groups with and without nutritional improvement. Prognostic factors were identified using the Cox proportional hazards regression analysis.
Median follow-up duration was 51 months. Of the 118 patients, 35 (29.7%) and 83 (70.3%) were in the group without and with nutritional intervention, respectively. Of the 83 patients in the group with nutritional intervention, 24 (28.9%) were classified as group without elevated prealbumin levels and 59 (71.1%) as group with elevated prealbumin levels. There was no difference in OS between the groups with and without nutritional intervention (P = 0.532); however, there was a trend toward better OS in the group with elevated prealbumin levels than in the group without elevated prealbumin levels (P = 0.181). Multivariate analysis showed that elevated prealbumin levels after intervention was an independent, favorable, prognostic factor for OS (hazard ratio, 0.320; 95% confidence interval, 0.112-0.917; P = 0.030).
Preoperative nutritional therapy in patients with severe malnutrition does not contribute to long-term survival after gastrectomy. However, in patients who have undergone nutritional therapy, prognosis could be predicted by elevated prealbumin levels.
本研究旨在阐明术前营养干预对严重营养不良患者胃癌根治术后长期生存的影响。
本回顾性队列研究纳入了2010年8月至2021年12月期间连续接受I-III期原发性胃癌根治术的患者。主要结局指标为总生存期（OS）。我们比较了接受营养干预和未接受营养干预组之间的OS。在干预组中，我们比较了营养状况改善和未改善组之间的OS。使用Cox比例风险回归分析确定预后因素。
中位随访时间为51个月。118例患者中，分别有35例（29.7%）和83例（70.3%）属于未接受营养干预组和接受营养干预组。在接受营养干预的83例患者中，24例（28.9%）被归类为前白蛋白水平未升高组，59例（71.1%）为前白蛋白水平升高组。接受营养干预和未接受营养干预组之间的OS无差异（P = 0.532）；然而，前白蛋白水平升高组的OS有优于未升高组的趋势（P = 0.181）。多因素分析显示，干预后前白蛋白水平升高是OS的独立、有利预后因素（风险比，0.320；95%置信区间，0.112 - 0.917；P = 0.030）。
严重营养不良患者的术前营养治疗对胃切除术后的长期生存无贡献。然而，在接受营养治疗的患者中，前白蛋白水平升高可预测预后。
