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Association of Obesity with Worse Operative and Oncologic Outcomes for Patients Undergoing Gastric Cancer Resection

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

How obesity has an impact on operative and oncologic outcomes for gastric cancer patients is unclear, and the influence of obesity on response to neoadjuvant chemotherapy (NAC) has not been evaluated.

Methods

Patients who underwent curative gastrectomy for primary gastric cancer between 2000 and 2018 were retrospectively identified. After stratification for NAC, operative morbidity, mortality, overall survival (OS), and disease-specific survival (DSS) were compared among three body mass index (BMI) categories: normal BMI (< 25 kg/m2), mild obesity (25–35 kg/m2), and severe obesity (≥ 35 kg/m2).

Results

During the study period, 984 patients underwent upfront surgery, and 484 patients received NAC. Tumor stage did not differ among the BMI groups. However, the rates of pathologic response to NAC were significantly lower for the patients with severe obesity (10% vs 40%; p < 0.001). Overall complications were more frequent among the obese patients (44.3% for obese vs 24.9% for normal BMI, p < 0.001). Intraabdominal infections were also more frequent in obese patients (13.9% for obese vs 4.7% for normal BMI, p = 0.001). In the upfront surgery cohort, according to the BMI, OS and DSS did not differ, whereas in the NAC cohort, severe obesity was independently associated with worse OS [hazard ratio (HR) 1.87; 95% confidence interval (CI) 1.01–3.48; p = 0.047] and disease-specific survival (DSS) (HR 2.08; 95% CI 1.07–4.05; p = 0.031).

Conclusion

For the gastric cancer patients undergoing curative gastrectomy, obesity was associated with significantly lower rates of pathologic response to NAC and more postoperative complications, as well as shorter OS and DSS for the patients receiving NAC.

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Acknowledgements

This research was supported in part by the NIH/NCI Cancer Center Support Grant P30 CA008748. We acknowledge Jessica Moore, MS, staff editor at MSK, for editing this manuscript.

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Authors and Affiliations

  1. Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Masaya Nakauchi MD, Elvira L. Vos MD, Sam S. Yoon MD, Murray F. Brennan MD, Daniel G. Coit MD & Vivian E. Strong MD, FACS

  2. Gastrointestinal Pathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Laura H. Tang MD

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Mithat Gonen PhD

  4. Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Yelena Y. Janjigian MD, Geoffrey Y. Ku MD, David H. Ilson MD & Steven B. Maron MD

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  1. Masaya Nakauchi MD
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  2. Elvira L. Vos MD
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Corresponding author

Correspondence to Vivian E. Strong MD, FACS.

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Disclosures

Yelena Y. Janjigian has received research funding from Rgenix, Boehringer Ingelheim, Bayer, Genentech/Roche, Bristol-Myers Squibb, Eli Lilly, and Merck and served on advisory boards for Rgenix, Merck Serono, Bristol-Myers Squibb, Eli Lilly, Pfizer, Bayer, Imugene, Merck, Daiichi-Sankyo, and AstraZeneca. Geoffrey Y. Ku has received honoraria and research funding from Merck, Bristol-Myers Squibb, and Pieris, and research funding from AstraZeneca, Zymeworks, and Daiichi Sankyo. David H. Ilson has received research funding from and served on advisory boards for Astellas, Eli Lilly, Pieris, and Taiho, and has served on advisory boards for Astra-Zeneca, Amgen, Bayer, Bristol-Myers Squibb, and Roche. Steven B. Maron has received research funding from Genentech and Guardant Health and has served on advisory boards for Natera and Basileahas. All the disclosed funding was provided to the institution for other studies. All the other authors declare that they have no financial relationships to disclose.

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Nakauchi, M., Vos, E.L., Tang, L.H. et al. Association of Obesity with Worse Operative and Oncologic Outcomes for Patients Undergoing Gastric Cancer Resection. Ann Surg Oncol 28, 7040–7050 (2021). https://doi.org/10.1245/s10434-021-09880-5

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  • DOI: https://doi.org/10.1245/s10434-021-09880-5

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