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

Figures & data

Figure 1. Study flow chart of inclusion and exclusion criteria. BSC, best supportive care; PS, performance status.

Table 1. Patient characteristics.

		All	RC (n = 69), %	NS (n = 34), %	*p-value
Median age (range)		71 (26–92)	71 (41–87)	71 (26–92)	–
Sex, %	Male/female	78.6/21.4	79.7/20.3	76.5/23.5	0.80
ECOG PS, %	0/1/2	56.3/29.1/14.6	65.2/21.7/13.0	38.2/44.1/17.6	0.03
BMI (kg/m^2), %	<18.5/18.5–25/≥25	23.3/67.0/9.7	27.5/62.3/10.1	14.7/76.5/8.8	0.33
Histology, %	Dif/Undif	48.0/52.0	50.0/50.0	44.1/55.9	0.67
HER2 status, %	Pos/Neg	17.5/82.5	18.8/81.2	14.7/85.3	0.78
Prior gastrectomy	Yes/No	23.3/76.7	30.4/69.6	8.8/91.2	0.01
No. of metastatic sites, %	1/≥2	51.5/48.5	55.1/44.9	44.1/55.9	0.40
PER metastasis, %	Pos/Neg	45.6/54.4	44.1/55.9	48.6/51.4	0.68
Regimen, %	Cis/Ox/Others	24.3/62.1/13.6	31.9/55.1/13.0	8.8/76.5/14.7	0.03
ALB (g/l)	<35/35≤	53.4/46.6	46.4/53.6	67.6/32.4	0.05
ALP (U/l), %	<ULN/≥ULN	72.8/27.2	72.5/27.5	73.5/26.5	1.00
LDH (U/l), %	<ULN/≥ULN	57.8/42.2	62.3/37.7	48.5/51.5	0.20
^1PNI	40>/40≤	51.5/48.5	21.7/78.3	44.1/55.9	0.02
NLR, %	<3/≥3	37.9/62.1	46.4/53.6	20.6/79.4	0.02
^2GPS, %	0/1/2	40.8/21.4/37.9	50.7/11.6/37.7	20.6/41.2/38.2	0.001

ALP, alkaline phosphatase; BMI, body mass index; ECOG PS, Eastern Cooperative Oncology Group performance status; Cis, cisplatin; Dif, differentiated; HER2, human epidermal growth factor 2; GPS, modified Glasgow prognostic score; LDH, lactate dehydrogenase; Neg, negative; NLR, neutrophil-to-lymphocyte ratio; NS, nutritional support group, Ox, oxaliplatin; PER, peritoneal; PNI, prognostic nutritional index; Pos, positive; RC, routine care group, ULN, upper limit of normal; Undif, undifferentiated.

¹PNI: 10*Alb + 0.005*lymphocyte count;

²GPS: CRP ≤ 10mg/l and Alb ≥35g/l (score 0), Alb < 35g/l or CRP > 10mg/l (score 1), Alb < 35g/l and CRP > 10mg/l (score 2); *p value was calculated by chi-square test.

Figure 2. Kaplan–Meier survival curves for overall survival and time to treatment failure for the entire cohort (A), Glasgow prognostic score 0 cohort (B), and Glasgow prognostic score 1 and 2 cohort (C). NS, nutritional support; OS, overall survival; RC, routine care; TTF, time to treatment failure.

Table 2. Univariate and multivariate analyses of factors associated with TTF and OS.

		TTF				OS
		Univariate analysis		Multivariate analysis		Univariate analysis		Multivariate analysis
		HR (95% CI)	p-value	HR (95% CI)	p-value	HR (95% CI)	p-value	HR (95% CI)	p-value
Nutritional support	with vs. without	0.67 (0.44–1.04)	0.07	0.53 (0.33–0.84)	0.01	0.99 (0.61–1.60)	0.97	0.82 (0.49–1.37)	0.45
PS	1–2 vs. 0	1.69 (1.13–2.53)	0.01	1.39 (0.87–2.23)	0.16	2.18 (1.39–3.40)	<0.001	1.29 (0.75–2.21)	0.34
BMI	18.5≤ vs. <18.5	1.55 (0.97–2.49)	0.06	1.53 (0.93–2.51)	0.09	1.82 (1.12–2.97)	0.02	2.03 (1.20–3.41)	0.007
Prior Gastrectomy	Yes vs. no	0.68 (0.42–1.11)	0.12			0.55 (0.32–0.96)	0.03	0.86 (0.44–1.66)	0.66
Histology	Undif vs. diff	1.28 (0.86–1.92)	0.21			1.07 (0.69–1.66)	0.75
HER2 status	Pos vs. neg	0.86 (0.51–1.46)	0.59			1.12 (0.63–2.01)	0.66
Peritoneal metastasis	Yes vs. no	1.40 (0.93–2.09)	0.10	1.43 (0.95-2.16)	0.08	1.89 (1.21–2.94)	0.01	1.56 (0.99–2.47)	0.05
Metastatic sites	≥2 vs. 1	1.21 (0.81–1.80)	0.33			1.33 (0.86–2.06)	0.19
ALP	≥ULN vs. <ULN	0.96 (0.61–1.51)	0.88			1.23 (0.76–2.00)	0.38
Regimen	(Cis/Ox/Others)	0.97 (0.68–1.38)	0.87			1.10 (0.78–1.56)	0.59
GPS	2 vs. 0-1	1.67 (1.11–2.52)	0.01	1.78 (1.09–2.90)	0.01	2.52 (1.60–4.00)	<0.001	2.25 (1.21–4.17)	0.001
LDH	≥ULN vs. <ULN	1.06 (0.71–1.59)	0.75			1.33 (0.85–2.07)	0.19
PNI	<40 vs. 40≤	1.10 (0.73–1.65)	0.64			1.23 (0.78–1.99)	0.36
NLR	≥3 vs. <3	1.09 (0.70–1.68)	0.69			1.44 (0.89–2.34)	0.13

CI, confidence interval; Cis, cisplatin; Dif, differentiated; GPS, Glasgow prognostic score; neg, negative; HER2, human epidermal growth factor 2; HR, hazard ratio; NLR, neutrophil-to-lymphocyte ratio; PNI, prognostic nutritional index; Pos, positive; Undif, undifferentiated; PS; performance status; TTF, time to treatment failure; Ox, oxaliplatin; OS, overall survival; ALP, alkaline phosphatase; LDH, lactate dehydrogenase.

Table 3. Adverse events.

	RC (n = 69)		NS (n = 34)		p-value
	All (%)	Grade 3–4 (%)	All (%)	Grade 3–4 (%)
Neutropenia	27.5	17.4	41.2	23.5	0.18
Anemia	62.3	21.7	79.4	20.6	0.11
Thrombocytopenia	21.7	8.7	26.5	2.9	0.75
Lymphocyte	53.6	14.5	70.6	14.7	0.13
Nausea	31.9	1.4	41.2	0	0.38
Diarrhea	11.6	0	29.4	5.9	0.05
Fatigue	31.9	0	47.1	2.9	0.19
Anorexia	59.4	10.1	61.8	11.8	1.00
Mucositis	5.8	0	11.8	2.9	0.43
Febrile neutropenia	–	4.3	–	8.8	0.39

NS, nutritional support; RC, routine care.

p-values were calculated using the chi-square test and comparing all events.

Data Availability Statement

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