Yang Liuqing, Zhang Qi, Zhang Heping, Shi Hanping
Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
Key Laboratory of Cancer FSMP for State Market Regulation, 10 Tie Yi Road, Beijing, 100038, China.
BMC Cancer. 2025 Jul 1;25(1):1037. doi: 10.1186/s12885-025-14421-4.
Nutrition impact symptoms (NIS) are common among cancer patients and influence prognosis. This study aimed to investigate the prognostic significance of NIS in gastric cancer patients using data from the Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) database.
We conducted a retrospective cohort study using data from 2,673 adult patients with confirmed gastric cancer enrolled in the INSCOC database between January 2013 to February 2020. NIS, including appetite loss, vomiting, dysphagia, and early satiety, were assessed using the Patient-Generated Subjective Global Assessment (PG-SGA). Overall survival (OS) was the primary outcome, while quality of life (QoL) was the secondary outcome. Statistical analyses included Kaplan-Meier survival analysis, Cox proportional hazards regression, and propensity score matching (PSM) to reduce confounding.
Patients with NIS had significantly worse OS compared to those without (median OS: 74.1 vs. 81.3 months, p < 0.001). In multivariate analysis, NIS was an independent predictor of mortality (HR: 1.28, 95% CI: 1.11-1.48, p = 0.001). Vomiting and dysphagia were particularly associated with increased mortality (HR: 1.22, p = 0.038 and HR: 1.80, p < 0.001, respectively). Interaction analysis revealed that the prognostic impact of NIS was influenced by chemotherapy (P for interaction = 0.002). NIS was also strongly associated with severe malnutrition. Sensitivity analysis confirmed the robustness of these findings, even after excluding short-term mortalities within 180 days.
NIS are significant independent predictors of poor prognosis in gastric cancer patients, contributing to malnutrition and reduced survival. These findings highlight the importance of early symptom recognition and nutritional intervention to potentially improve outcomes for gastric cancer patients.
https://www.chictr.org.cn/showproj.html?proj=31813 , identifier ChiCTR1800020329.
营养影响症状（NIS）在癌症患者中很常见，并影响预后。本研究旨在利用常见癌症营养状况与临床结局调查（INSCOC）数据库的数据，探讨NIS在胃癌患者中的预后意义。
我们进行了一项回顾性队列研究，使用了2013年1月至2020年2月期间纳入INSCOC数据库的2673例确诊为胃癌的成年患者的数据。使用患者主观整体评定法（PG-SGA）评估NIS，包括食欲减退、呕吐、吞咽困难和早饱。总生存期（OS）是主要结局，生活质量（QoL）是次要结局。统计分析包括Kaplan-Meier生存分析、Cox比例风险回归和倾向评分匹配（PSM）以减少混杂因素。
与无NIS的患者相比，有NIS的患者OS显著更差（中位OS：74.1个月对81.3个月，p<0.001）。在多变量分析中，NIS是死亡率的独立预测因素（HR：1.28，95%CI：1.11-1.48，p=0.001）。呕吐和吞咽困难与死亡率增加尤其相关（HR分别为：1.22，p=0.038和HR：1.80，p<0.001）。交互分析显示，NIS的预后影响受化疗影响（交互作用P=0.002）。NIS也与严重营养不良密切相关。敏感性分析证实了这些发现的稳健性，即使排除180天内的短期死亡病例后也是如此。
NIS是胃癌患者预后不良的重要独立预测因素，导致营养不良和生存期缩短。这些发现突出了早期症状识别和营养干预对潜在改善胃癌患者结局的重要性。
https://www.chictr.org.cn/showproj.html?proj=31813 ，标识符ChiCTR1800020329。
