The Impact of Nutritional Support on Survival Outcomes in Patients with Advanced Gastric Adenocarcinoma Treated with Chemotherapy

Abstract

Malnutrition and cachexia occur commonly in patients with advanced gastric cancer (AGC). This study elucidated the effect of nutritional support (NS) on survival outcomes among patients with AGC undergoing chemotherapy. We retrospectively evaluated new AGC cases at our institute between January 2015 and January 2021. Inclusion criteria were unresectable or recurrent chemotherapy-treated gastric adenocarcinoma, ECOG performance status (PS) 0–2, and adequate organ function. Time to treatment failure (TTF) and overall survival (OS) were evaluated, and univariate and multivariate analyses identified prognostic factors. A total of 103 eligible patients were separated into groups: 69 patients (67%) into NS and 34 (33%) into routine care (RC). The median follow-up time was 11.0 mo, (0.5–92). NS was offered to patients with poorer PS (p = 0.03), Glasgow prognostic score (GPS) positivity (p = 0.001), and high neutrophil-to-lymphocyte ratios (cut-off ≤ 3, p = 0.02). Median OS and TTF in the RC and NS groups were 11.6 and 10.4 mo, (p = 0.99) and 4.2 and 5.5 mo, (p = 0.07), respectively. Multivariate analyses identified NS (hazard ratio [HR] = 0.53, p = 0.01) and GPS positivity for TTF, and low body mass index (HR = 2.03, p = 0.007) and GPS positivity (HR = 2.25, p = 0.001) for OS as significant prognostic factors. Thus, NS with chemotherapy is a potentially effective intervention for AGC.

Acknowledgments

The authors thank Editage (www.editage.jp) for English language editing. The authors also thank all the nutritionists, medical assistants (M.H), and medical information manager (M.Y) at Nagoya medical center.

Author Contributions

Keiji Sugiyama contributed to the conception and the design of the study; Keiji Sugiyama, Kazuhiro Shiraishi, Takuya Motohashi, and Shinpei Onoda collected, analyzed, and interpreted the data; Keiji Sugiyama, Kazuhiro Shiraishi, Mariko Sato, Kyoko Kato grafted the manuscript; Masashi Hattori, Masaya Suenaga, Noboru Hirashima, Masaaki Shimada, Masato Kataoka, Chiyoe Kitagawa revised the manuscript. All authors agree to be fully accountable for ensuring the integrity and accuracy of the work and have read and approved the final manuscript.

Disclosure Statement

The authors have no conflict of interest to declare regarding this study.

Data Availability Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.