Journal of Gastric Cancer

  • 제22권1호
  • /
  • Pages.56-66
  • /
  • 2022
  • /
  • 2093-582X(pISSN)
  • /
  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
권호 표지
DOI QR코드

DOI QR Code

Nutritional Status Indicators Affecting the Tolerability of Postoperative Chemotherapy After Total Gastrectomy in Patients With Gastric Cancer

  • 투고 : 2021.10.05
  • 심사 : 2022.02.15
  • 발행 : 2022.03.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Nutritional problems after gastrectomy affect continuation of postoperative chemotherapy. There have been no studies limited to total gastrectomy, which is particularly prone to nutritional problems. In this study, we aimed to investigate the factors that predict the continuation of postoperative chemotherapy. Materials and Methods: We included 101 patients who underwent curative total gastrectomy and postoperative chemotherapy at Hiroshima Memorial Hospital. The effects of 37 factors, including perioperative inflammatory, nutritional, and tumor status, on the persistence of postoperative chemotherapy were analyzed. Results: In univariate analysis of preoperative factors, age, carbohydrate antigen 19-9, platelet-to-neutrophil ratio, Onodera's prognostic nutritional index (PNI), controlling nutritional status score, and nutritional risk screening (NRS-2002) score were significantly associated with the duration of postoperative chemotherapy. In multivariate analysis of preoperative factors, age (≥74 years) was an independent factor for a shorter duration of postoperative chemotherapy (hazard ratio [HR], 5.24; 95% confidence interval [CI], 2.19-12.96; P<0.01). In univariate analysis of factors before postoperative chemotherapy, intraoperative blood loss, perioperative weight loss rate, postoperative performance status, PNI, albumin-to-bilirubin index, and NRS-2002 score were significantly associated with the duration of postoperative chemotherapy. In multivariate analysis of factors before postoperative therapy, age (≥74 years) (HR, 5.75; 95% CI, 1.90-19.49; P<0.01) and PNI (<39) (HR, 3.29; 95% CI, 1.26-8.56; P=0.02) were independent factors for a shorter duration of postoperative chemotherapy. Conclusions: Age and PNI are useful predictors of postoperative chemotherapy intolerance after total gastrectomy and may determine the treatment strategy and timing of chemotherapy initiation.

키워드

참고문헌

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424. https://doi.org/10.3322/caac.21492
  2. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355:11-20. https://doi.org/10.1056/NEJMoa055531
  3. Schuhmacher C, Gretschel S, Lordick F, Reichardt P, Hohenberger W, Eisenberger CF, et al. Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: European Organisation for Research and Treatment of Cancer randomized trial 40954. J Clin Oncol 2010;28:5210-5218. https://doi.org/10.1200/JCO.2009.26.6114
  4. Ychou M, Boige V, Pignon JP, Conroy T, Bouche O, Lebreton G, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 2011;29:1715-1721. https://doi.org/10.1200/JCO.2010.33.0597
  5. Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 2007;357:1810-1820. https://doi.org/10.1056/NEJMoa072252
  6. Bang YJ, Kim YW, Yang HK, Chung HC, Park YK, Lee KH, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet 2012;379:315-321. https://doi.org/10.1016/S0140-6736(11)61873-4
  7. Yoshida K, Kodera Y, Kochi M, Ichikawa W, Kakeji Y, Sano T, et al. Addition of docetaxel to oral fluoropyrimidine improves efficacy in patients with stage III gastric cancer: interim analysis of JACCRO GC-07, a randomized controlled trial. J Clin Oncol 2019;37:1296-1304. https://doi.org/10.1200/JCO.18.01138
  8. Aoyama T, Yoshikawa T, Shirai J, Hayashi T, Yamada T, Tsuchida K, et al. Body weight loss after surgery is an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer. Ann Surg Oncol 2013;20:2000-2006. https://doi.org/10.1245/s10434-012-2776-6
  9. Aoyama T, Sato T, Maezawa Y, Kano K, Hayashi T, Yamada T, et al. Postoperative weight loss leads to poor survival through poor S-1 efficacy in patients with stage II/III gastric cancer. Int J Clin Oncol 2017;22:476-483. https://doi.org/10.1007/s10147-017-1089-y
  10. Takahashi M, Terashima M, Kawahira H, Nagai E, Uenosono Y, Kinami S, et al. Quality of life after total vs distal gastrectomy with Roux-en-Y reconstruction: use of the Postgastrectomy Syndrome Assessment Scale-45. World J Gastroenterol 2017;23:2068-2076. https://doi.org/10.3748/wjg.v23.i11.2068
  11. Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T, et al. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol 2011;29:4387-4393. https://doi.org/10.1200/JCO.2011.36.5908
  12. Takahari D, Hamaguchi T, Yoshimura K, Katai H, Ito S, Fuse N, et al. Feasibility study of adjuvant chemotherapy with S-1 plus cisplatin for gastric cancer. Cancer Chemother Pharmacol 2011;67:1423-1428. https://doi.org/10.1007/s00280-010-1432-8
  13. Shitara K, Chin K, Yoshikawa T, Katai H, Terashima M, Ito S, et al. Phase II study of adjuvant chemotherapy of S-1 plus oxaliplatin for patients with stage III gastric cancer after D2 gastrectomy. Gastric Cancer 2017;20:175-181. https://doi.org/10.1007/s10120-015-0581-1
  14. Inaoka K, Kanda M, Uda H, Tanaka Y, Tanaka C, Kobayashi D, et al. Clinical utility of the plateletlymphocyte ratio as a predictor of postoperative complications after radical gastrectomy for clinical T2-4 gastric cancer. World J Gastroenterol 2017;23:2519-2526. https://doi.org/10.3748/wjg.v23.i14.2519
  15. Iizuka A, Kanda M, Ito S, Mochizuki Y, Teramoto H, Ishigure K, et al. Proposal of a scoring scale to estimate risk of the discontinuation of S-1 adjuvant monotherapy in patients with stage II to III gastric cancer: a multi-institutional dataset analysis. World J Surg 2019;43:2016-2024. https://doi.org/10.1007/s00268-019-04942-y
  16. Miwa T, Kanda M, Tanaka C, Kobayashi D, Hayashi M, Yamada S, et al. Albumin-bilirubin score predicts tolerability to adjuvant S-1 monotherapy after curative gastrectomy. J Gastric Cancer 2019;19:183-192. https://doi.org/10.5230/jgc.2019.19.e15
  17. Xiao H, Zhou H, Zhang P, Xiao H, Liu K, Chen X, et al. Association among the prognostic nutritional index, completion of adjuvant chemotherapy, and cancer-specific survival after curative resection of stage II/III gastric cancer. Eur J Clin Nutr 2020;74:555-564. https://doi.org/10.1038/s41430-019-0502-1
  18. Yamashita K, Kurokawa Y, Yamamoto K, Hirota M, Kawabata R, Mikami J, et al. Risk factors for poor compliance with adjuvant S-1 chemotherapy for gastric cancer: a multicenter retrospective study. Ann Surg Oncol 2017;24:2639-2645. https://doi.org/10.1245/s10434-017-5923-2
  19. Jang SH, Jung YJ, Kim MG, Kwon SJ. The prognostic significance of compliance with postoperative adjuvant chemotherapy in patients with stage III gastric cancer: an observational study. J Gastric Cancer 2018;18:48-57. https://doi.org/10.5230/jgc.2018.18.e4
  20. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nippon Geka Gakkai Zasshi 1984;85:1001-1005.
  21. Sakurai K, Ohira M, Tamura T, Toyokawa T, Amano R, Kubo N, et al. Predictive potential of preoperative nutritional status in long-term outcome projections for patients with gastric cancer. Ann Surg Oncol 2016;23:525-533. https://doi.org/10.1245/s10434-015-4814-7
  22. Matsumoto H, Okamoto Y, Kawai A, Ueno D, Kubota H, Murakami H, et al. Prognosis prediction for postoperative esophageal cancer patients using Onodera's prognostic nutritional index. Nutr Cancer 2017;69:849-854. https://doi.org/10.1080/01635581.2017.1339093
  23. Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg 2011;98:268-274. https://doi.org/10.1002/bjs.7305
  24. Tanemura A, Mizuno S, Hayasaki A, Gyoten K, Fujii T, Iizawa Y, et al. Onodera's prognostic nutritional index is a strong prognostic indicator for patients with hepatocellular carcinoma after initial hepatectomy, especially patients with preserved liver function. BMC Surg 2020;20:261. https://doi.org/10.1186/s12893-020-00917-2
  25. Broggi MS, Patil D, Baum Y, Nieh PT, Alemozaffar M, Pattaras JG, et al. Onodera's prognostic nutritional index as an independent prognostic factor in clear cell renal cell carcinoma. Urology 2016;96:99-105. https://doi.org/10.1016/j.urology.2016.05.064
  26. Yenibertiz D, Ozyurek BA, Erdogan Y. Is Onodera's prognostic nutritional index (OPNI) a prognostic factor in small cell lung cancer (SCLC)? Clin Respir J 2020;14:689-694. https://doi.org/10.1111/crj.13185
  27. Ihara K, Yamaguchi S, Shida Y, Fujita J, Matsudera S, Kikuchi M, et al. Nutritional status predicts adjuvant chemotherapy outcomes for stage III colorectal cancer. J Anus Rectum Colon 2019;3:78-83. https://doi.org/10.23922/jarc.2018-031
  28. Sagawa M, Yoshimatsu K, Yokomizo H, Osawa G, Matsumoto A, Yano Y, et al. Assessment of host status in patients treated with mFOLFOX6 adjuvant chemotherapy after colorectal cancer surgery. Gan To Kagaku Ryoho 2013;40:1587-1589.
  29. Ihara K, Yamaguchi S, Shida Y, Ogata H, Domeki Y, Okamoto K, et al. Poor nutritional status before and during chemotherapy leads to worse prognosis in unresectable advanced or recurrent colorectal cancer. Int Surg. Forthcoming 2015.
  30. Bozkaya Y, Kostek O, Sakin A, Ozyukseler DT, Sakalar T, Cil I. Is the prognostic nutritional index a prognostic and predictive factor in metastatic non-small cell lung cancer patients treated with first-line chemotherapy? Support Care Cancer 2020;28:2273-2282. https://doi.org/10.1007/s00520-019-05055-x
  31. Go SI, Jeon H, Park SW, Kang MH, Kim HG, Lee GW. Low pre-treatment nutritional index is significantly related to poor outcomes in small cell lung cancer. Thorac Cancer 2018;9:1483-1491. https://doi.org/10.1111/1759-7714.12862
  32. Matsumoto Y, Zhou Q, Kamimura K, Moriyama M, Saijo Y. The prognostic nutrition index predicts the development of hematological toxicities in and the prognosis of esophageal cancer patients treated with cisplatin plus 5-fluorouracil chemotherapy. Nutr Cancer 2018;70:447-452. https://doi.org/10.1080/01635581.2018.1445765
  33. Kono T, Sakamoto K, Shinden S, Ogawa K. Pre-therapeutic nutritional assessment for predicting severe adverse events in patients with head and neck cancer treated by radiotherapy. Clin Nutr 2017;36:1681-1685. https://doi.org/10.1016/j.clnu.2016.10.021