Background: Cachexia affects nearly 50–80% of cancer patients, and most studies have only focused on elderly patients. We investigated preoperative cachexia in gastric cancer (GC) patients by age group and comprehensively analyzed the impact of preoperative cachexia on the prognosis of GC patients in all age groups.
Methods: In total, 575 patients were prospectively analyzed. The effect of preoperative cachexia on overall survival (OS) in all the patients and in patients with different age groups were investigated using log-rank test and Cox proportional hazards regression, respectively.
Results: In total, 35.8% (206 of 575) individuals were diagnosed with cachexia. The median survival of cachexia patients (29.2 months) was shorter than that of non-cachexia patients (35.7 months). Cachexia (HR =1.976, P<0.001), age (HR =1.811, P<0.001), readmission (HR =2.559, P<0.001), tumor size (HR =1.639, P=0.003), TNM stage (stage II: HR =2.215, P=0.017; stage III: HR =5.758, P<0.001), whole stomach cancer (HR =2.639, P<0.001), and combined operation (HR =1.598, P=0.032) were independently associated with worse OS. After grouping by age, cachexia was associated with OS in patients younger than 50 years old (HR =4.947, P=0.029), patients 51–60 years old (HR =2.232, P=0.026), and patients 61–70 years old (HR =1.806, P=0.032), but not in patients older than 71 years (HR =1.411, P=0.119). Further, cachexia only significantly affected the postoperative length of stay (P=0.015) and hospitalization costs (P=0.032) in patients younger than 50 years old.
Conclusions: Preoperative cachexia predicts poor outcome in younger GC patients, and greater attention should be paid to these patients.
Keywords: cachexia, gastric cancer, overall survival, younger patients
Cancer cachexia, also known as cancer-related wasting syndrome and cancer anorexia-cachexia syndrome, is a multifactorial syndrome defined by an ongoing loss of skeletal muscle mass, with or without loss of fat mass, that cannot be fully reversed by conventional nutritional support, leading to progressive functional impairment.1 It is also an indicator of tumor progression in patients with malignancy.2 Recently, cachexia has been receiving increasing attention because of its high prevalence, affecting nearly 50–80% of cancer patients, depending on the tumor type.3 Further, it may be the leading cause of nearly 20% of cancer deaths.3,4
The inability to prevent weight loss through nutritional intervention is one of several important distinctions between cancer cachexia and simple starvation.1 Moreover, the co-occurrence of cancer, especially gastrointestinal cancer, and cachexia greatly weakens the patient’s ability to recover. Bachmann et al demonstrated that pancreatic cancer patients with cachexia experienced a greater decline in survival,5 and Fukuta et al reported that preoperative cachexia greatly increased the postoperative length of stay in elderly patients with gastrointestinal cancer.6 Another report stated that the risk of inpatient death was higher for gastric cancer (GC) patients with cachexia.7 However, few studies have focused on the impact of cachexia on the long-term survival of GC patients, and most such studies only examined elderly patients.
Therefore, the relationship between GC and cachexia still needs to be fully elucidated to develop effective therapeutic strategies that consider this relationship. This study aimed to comprehensively evaluate the potential prognostic utility of cachexia in GC patients, including examining the differences between younger and elderly patients.
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