Preoperative Cachexia predicts poor outcomes in young rather than elderly gastric cancer patients: a prospective study

Figures & data

Table 1 Demographics, patient characteristics in overall study population and by cachexia group

Factors	Total (n=575)	Non-cachexia (n=369)	Cachexia (n=206)	P-value
Gender				0.668
Male	433 (75.3%)	280 (75.9%)	153 (74.3%)
Female	142 (24.7%)	89 (24.1%)	53 (25.7%)
Age (y)	64.41±10.6	63.24±10.4	66.49±10.8	<0.001*
BMI (kg/m2)	22.21 (20.20—24.22)	22.50 (20.57—24.61)	21.51 (19.54—23.7)	<0.001*
PLR	169.87±95.8	159.94±92.1	187.70±99.9	0.001*
NLR	2.71±2.0	2.56±1.6	3.17±2.5	<0.001*
Skeletal muscle (cm2)	41.98 (35.86—47.93)	42.92 (37.45—48.90)	39.52 (34.43—46.99)	<0.001*
Grip strength (kg)	28.90 (22.0—35.5)	30.25 (23.4—41.1)	26.00 (19.9—32.9)	<0.001*
Stride speed (m/s)	1.00±0.2	0.99±0.2	0.96±0.3	0.246
Preoperative hemoglobin	120.83±22.0	124.15±21.1	114.87±22.5	<0.001*
Preoperative albumin	38.50 (34.95—41.50)	39.20 (35.70—41.90)	37.20 (33.65—40.2)	<0.001*
ASA				0.001*
1–2	475 (82.6%)	319 (86.4%)	156 (75.7%)
3–4	100 (17.4%)	50 (13.6%)	50 (24.3%)
Charison scroe				<0.001*
0	293 (51.0%)	214 (58.0%)	79 (38.3%)
1–3	260 (45.2%)	149 (40.4%)	111 (53.9%)
4–6	22 (3.8%)	6 (1.6%)	16 (7.8%)
Preoperative anaemia				<0.001*
No	475 (82.6%)	322 (87.3%)	153 (74.3%)
Yes	100 (13.4%)	47 (12.7%)	53 (25.7%)
Preoperative bleeding				0.006*
No	487 (84.7%)	324 (87.8%)	163 (79.1%)
Yes	88 (15.3%)	45 (12.2%)	43 (20.9%)
Preoperative obstruction				<0.001*
No	521 (90.6%)	361 (97.8%)	160 (77.7%)
Yes	54 (9.4%)	8 (0.2%)	46 (22.3%)
Tumor location				0.04*
Cardia	73 (12.7%)	39 (10.6%)	34 (16.5%)
Body	116 (20.2%)	77 (20.9%)	39 (18.9%)
Antrum	364 (63.3%)	243 (65.9%)	121 (58.7%)
Total	22 (3.8%)	10 (2.6%)	12 (5.9%)
Tumor size				0.016*
≤4.75	372 (64.7%)	252 (68.3%)	120 (58.3%)
>4.75	203 (35.3%)	117 (31.7%)	86 (41.7%)
Histopathological differentiation				0.091
Differentiated	422 (73.4%)	273 (74.0%)	149 (72.3%)
Undifferentiated	51 (8.9%)	26 (7.0%)	25 (12.2%)
Signet ring cell carcinoma	102 (17.7%)	70 (19.0%)	32 (15.5%)
Pathologic type				<0.001*
Ulcerative type	504 (87.7%)	337 (91.3%)	167 (81.1%)
Non-ulcerative type	71 (12.3%)	32 (8.7%)	39 (18.9%)
TNM stage				<0.001*
I	185 (32.2%)	145 (39.3%)	40 (19.4%)
II	124 (21.6%)	76 (20.6%)	48 (23.3%)
III	266 (46.2%)	148 (40.1%)	118 (57.3%)
Surgical bleeding				0.066
No	500 (87.0%)	328 (88.9%)	172 (83.5%)
Yes	75 (13.0%)	41 (11.1%)	34 (16.5%)
Operation time				0.673
≤210min	311 (54.1%)	202 (54.7%)	109 (52.9%)
>210min	264 (45.9%)	167 (45.3%)	97 (47.1%)
Abdominal surgery history				0.38
No	506 (88.0%)	328 (88.9%)	178 (86.4%)
Yes	69 (12.0%)	41 (11.1%)	28 (13.6%)
Length of stay (d)	15.77±9.36	14.97±9.39	17.19±9.17	0.006
Total cost (yuán)	64,297.95±30,643.86	61,791.02±32,846.58	68,788.52±25,709.93	0.009

Notes: Data are presented as n (%), mean ± SD, or median [IQR] unless otherwise indicated. *Statistically significant (P<0.05).

Abbreviations: BMI, body mass index; ASA, American Society of Anaesthesiologists; NLR, neutrophil/lymphocyte ratio; PLR, platelet/lymphocyte ratio; TNM, Tumor-Lymph, Node, Metastasis.

Table 2 COX regression analysis of the relationship between OS and cachexia or patient characteristics

Factors	Univariate		Multivariate
	HR (95% CI)	P-value	HR (95% CI)	P-value
Gender
Male	Reference
Female	1.292 (0.899–1.856)	0.166
Age
<70	Reference		Reference
≥70	2.107 (1.569–2.830)	<0.001*	1.811 (1.334–2.458)	<0.001*
BMI (kg/m2)
18.5—23.5	Reference
<18.5	1.781 (1.120–2.834)	0.015*
>23.5	0.949 (0.686–1.313)	0.752
ASA
1–2	Reference
3–4	1.654 (1.173–2.332)	0.004*
Charison scroe
0	Reference
1–3	1.412 (1.041–1.914)	0.026*
4–6	2.133 (1.103–4.126)	0.024*
PLR
≤131.1	Reference
>131.1	1.336 (0.978–1.825)	0.068
NLR
≤2.28	Reference
>2.28	1.482 (1.101–1.994)	0.009*
Preoperative Grip strength
Normal	Reference
Low	1.858 (1.365–2.530)	<0.001*
Preoperative anemia
No	Reference
Yes	1.520 (1.072–2.155)	0.019*
Preoperative hypoalbuminemia
No	Reference
Yes	2.344 (1.272–4.320)	0.006*
Surgery history
No	Reference
Yes	1.275 (0.835–1.946)	0.260
Readmission
No	Reference		Reference
Yes	1.940 (1.218–3.089)	0.005*	2.559 (1.562–4.191)	<0.001*
Cachexia
No	Reference		Reference
Yes	1.976 (1.471–2.653)	<0.001*	1.456 (1.070–1.981)	0.017*
Tumor size
≤4.75	Reference		Reference
>4.75	2.830 (2.102–3.810)	<0.001*	1.639 (1.187–2.261)	0.003*
Histopathological differentiation
Differentiated	Reference
Undifferentiated	1.519 (0.948–2.434)	0.082
Pathologic type
Ulcerative type	Reference
Non-ulcerative type	0.712 (0.473–1.073)	0.105
TNM stage
I	Reference		Reference
II	2.747 (1.480–5.098)	<0.001*	2.215 (1.155–4.248)	0.017*
III	7.823 (4.654–13.149)	<0.001*	5.758 (3.285–10.094)	<0.001*
Tumor location
Cardia	Reference		Reference
Body	0.940 (0.548–1.611)	0.821	1.044 (0.6–1.817)	0.878
Antrum	0.941 (0.594–1.489)	0.795	1.118 (0.697–1.793)	0.643
Total	4.125 (2.159–7.879)	<0.001*	2.639 (1.358–5.130)	<0.001*
Anastomotic method
Billroth I	Reference
Billroth II	2.612 (1.661–4.108)	<0.001*
Roux-en-y	2.909 (2.004–4.224)	<0.001*
Intraoperative blood transfusion
No	Reference
Yes	2.844 (1.833–4.411)	<0.001*
Intraoperative bleeding
No	Reference
Yes	2.835 (1.813–4.434)	<0.001*
Postoperative complications above grade 2
No	Reference
Yes	2.095 (1.526–2.877)	<0.001*
Combined operation
No	Reference		Reference
Yes	2.284 (1.515–3.444)	<0.001*	1.598 (1.042–2.449)	0.032*

Notes: Data are presented as median [IQR]. *Statistically significant (P<0.05).

Abbreviations: BMI, body mass index; ASA, American Society of Anaesthesiologists; NLR, neutrophil/lymphocyte ratio; PLR, platelet/lymphocyte ratio; TNM, Tumor-Lymph, Node, Metastasis.

Figure 1 Kaplan–Meier curve for overall survival (OS) in patients with and without cachexia.

Figure 2 Frequency distribution of patients of different ages stratum with and without cachexia.

Table 3 COX regression analysis of the relationship between OS and cachexia in patients with different ages

Group	HR (95% CI)	P-value
≤50 y	4.947 (1.181–20.727)	0.029*
51–60 y	2.232 (1.103–4.518)	0.026*
61–70 y	1.806 (1.052–3.098)	0.032*
≥71 y	1.411 (0.915–2.174)	0.119

Notes: Data are presented as median [IQR]. *Statistically significant (P<0.05).

Figure 3 (A) Kaplan–Meier curve for overall survival (OS) in different ages stratum with and without cachexia. (B) Total cost and length of hospital stay in different ages stratum with and without cachexia.