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Prognostic significance of the cachexia index in patients with unresectable advanced gastric cancer receiving palliative chemotherapy: a retrospective single-center study

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Abstract

Purpose

To investigate the prognostic utility of the cachexia index (CXI) in unresectable advanced gastric cancer (UAGC).

Methods

The relationship between CXI and the outcomes was evaluated in 102 patients with UAGC who had received first-line palliative 5-fluorouracil-based chemotherapy between January 2012 and December 2021.

Results

The median survival time (MST) from first-line chemotherapy initiation was 16.2 months, and the cohort included 60 and 42 patients with high and low CXIs, respectively, based on the optimal CXI cutoff. The rates of patients with a performance status score of 0, recurrence, third-line chemotherapy, and all grade 3–4 side effects, including febrile neutropenia (FN), were significantly higher in the CXIhigh group than in the CXIlow group. The prognosis based on MST was significantly better in the CXIhigh group than in the CXIlow group (22.5 vs. 11.6 months, p < 0.001). According to a multivariate analysis, a low CXI and performance status score of 1–2 were poor prognostic factors.

Conclusions

Patients with UAGC and a low CXI had poorer prognoses and more frequent grade 3–4 side effects, including FN, than those with a high CXI. Patients with UAGC and a low CXI should be carefully managed to control for side effects to receive subsequent treatment.

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Availability of data and materials

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

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Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English language review.

Funding

The authors received no grants, equipment, or funding for this study.

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Authors and Affiliations

  1. Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-Cho, Yonago, 683-8504, Japan

    Tomoyuki Matsunaga, Yu Sakano, Masahiro Makinoya, Shota Shimizu, Yuji Shishido, Kozo Miyatani, Takehiko Hanaki, Kyoichi Kihara, Manabu Yamamoto, Naruo Tokuyasu, Shuichi Takano, Teruhisa Sakamoto, Toshimichi Hasegawa & Yoshiyuki Fujiwara

  2. Department of Surgery, Japanese Red Cross Tottori Hospital, 117 Shotoku-Cho, Tottori, 680-8517, Japan

    Hiroaki Satio

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Correspondence to Tomoyuki Matsunaga.

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Ethics approval and consent to participate

All procedures were carried out following the ethical standards of the responsible committee on human experimentation (institutional and national), as well as the 1964 Declaration of Helsinki and subsequent revisions. The study protocol was approved by the Tottori University Hospital Ethics Committee (approval: 20A243). In this retrospective study, patients were not required to provide their informed consent because the analyses relied on anonymous clinical data obtained after each patient agreed to treatment in writing. We also used an opt-out method to obtain consent for this study on the website, which was approved by the institutional review board.

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Matsunaga, T., Satio, H., Sakano, Y. et al. Prognostic significance of the cachexia index in patients with unresectable advanced gastric cancer receiving palliative chemotherapy: a retrospective single-center study. Surg Today 54, 231–239 (2024). https://doi.org/10.1007/s00595-023-02721-w

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