| Objective:The purpose of this study was to investigate the predictive value of preoperative weight change on short-term postoperative complications and long-term survival in patients with resectable gastric cancer.Methods:A retrospective analysis of 1266 patients with gastric adenocarcinoma who underwent radical resection for gastric cancer admitted to the First Hospital of Lanzhou University from April 1,2015 to September 30,2020.Patient demographics,clinicopathological data,surgery-related indicators,intraoperative indicators,and specific postoperative complications are obtained through the electronic medical record system,while patients are followed up by telephone for short-and long-term prognostic information.The weight of patients 4-12 weeks before surgery(control weight)and the weight at the time of surgical hospitalization(preoperative weight)were collected,and the rate of change of patients’preoperative weight was calculated.The subject work characteristic curve(ROC)was used to determine the optimal cut-off value for weight loss.The preoperative weight change was divided into three groups according to the results obtained:group A(no weight loss,0%),group B(0%<weight loss<7%),and group C(weight loss≥7%),and the differences in clinicopathological characteristics,intraoperative indices,and short-term postoperative complications were compared among the three groups.In addition,their long-term prognosis was assessed using Kaplan-Meier curves,and the Log-Rank test was used for comparison between groups.The influence factors of OS were analyzed by COX proportional risk regression,and P<0.05 was considered a statistically significant difference.Finally,column line plots were constructed based on the results of the COX regression analysis of OS and used as a visual supplement to the prognostic scoring system.Results:1.The subject work characteristic curve(ROC)was used to determine the optimal cut-off value for weight loss,and a result of 7%was obtained.2.The three groups differed in age,BMI,tumor size,pTNM stage,degree of differentiation,surgical approach,extent of surgical resection,postoperative complications,and length of postoperative hospital stay(P<0.005).Among the included1266 gastric cancer patients,a total of 256 patients had short-term postoperative complications,with a complication rate of 20.2%.Among them,the number of complications in group A(no weight loss,0%),group B(0%<weight loss<7%),and group C(weight loss≥7%)were 51,94,and 111,respectively,and the complication rates were19.9%,26.5%and 31.8%,respectively.209(81.6%)of the 256 patients with complications presented with a single complication,and the rest combined one or The remaining patients had one or more complications.The highest incidence of complications was pulmonary infection,with 148 cases,accounting for 42.2%of the overall complication rate.Among the three groups of patients,the incidence of pulmonary infection in group C was 48.0%,which was significantly higher than that in groups A(15.5%)and B(36.5%).3.Univariate and multifactorial analyses were performed to determine the factors influencing short-term postoperative complications.The results of univariate analysis showed that preoperative weight loss,BMI,tumor site,NAC,surgical method,and postoperative length of hospital stay were influential factors for the occurrence of short-term complications after resectable gastric cancer(P<0.05).The results of multifactorial analysis showed that preoperative weight loss≥7%,BMI<18.5 kg/m2,intraoperative bleeding≥200 ml,and length of postoperative hospital stay were independent risk factors for short-term complications after resectable gastric cancer(P<0.05).4.The Kaplan-Meier method was used to plot the overall survival curves of the three groups of patients,and Log-rank was used to test the significance between groups.The results showed that the overall survival rates in groups A,B and C:1-year OS was94.0%,92.1%and 81.3%,3-year OS was 83.9%,76.2%and 54.5%,and 5-year OS was78.9%,70.2%and 41.7%,respectively,with statistically significant differences(P<0.001).Subgroup analysis was performed for the three groups of patients according to their different pathological stages(p TNM).The results showed that the overall survival rates of stage I,II,and III patients in groups A,B,and C were different,and the differences were statistically significant(P<0.05).The three groups of patients were analyzed in subgroups according to the different degrees of pathological differentiation.The results showed statistically significant differences in OS among the three groups of patients in the low differentiation subgroup(P<0.001),no significant differences among the three groups of patients in the high differentiation subgroup(P=0.775),and statistically significant differences between groups C and A and C and B in the medium differentiation subgroup,with P values of 0.002 and 0.006,respectively,while no statistically significant differences between groups A and B(P=0.845).5.COX regression analysis was performed on the included 1266 patients.The results of multifactorial analysis showed that age,weight loss,tumor size,p T stage,p N stage,and differentiation were independent prognostic factors affecting OS(P<0.05).The prognostic model of"line graph"was constructed and internally validated by incorporating the above influencing factors using R language,and the results showed good predictive effect.Conclusion:1.Preoperative weight loss affects the occurrence of short-term postoperative complications in patients with resectable gastric cancer,and the more significant the weight loss(≥7%),the higher the incidence of postoperative complications.2.Preoperative weight loss≥7%,BMI<18.5 kg/m~2,intraoperative bleeding≥200m L,and length of postoperative hospital stay were independent risk factors affecting the occurrence of short-term postoperative complications in patients with resectable gastric cancer.3.Preoperative weight loss is an independent risk factor for long-term postoperative prognosis in patients with resectable gastric cancer,and preoperative weight loss predicts poor survival outcomes in patients with resectable gastric cancer.4.The column line chart constructed based on the pTNM staging system combined with preoperative weight change and other prognostic factors is a convenient and effective clinical prognostic prediction model. |
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