• Gastric adenocarcinoma
• Morbidity
• Obesity
• Overweight
• Surgery

• Humans
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Stomach Neoplasms/complications
• Female
• Male
• Adenocarcinoma/surgery
• Adenocarcinoma/pathology
• Adenocarcinoma/complications
• Obesity/complications
• Obesity/epidemiology
• Retrospective Studies
• Middle Aged
• Postoperative Complications/epidemiology
• Aged
• Europe/epidemiology
• Gastrectomy
• Body Mass Index
• Neoplasm Staging
• Overweight/complications
• Overweight/epidemiology
• Reoperation/statistics & numerical data
• Lymph Node Excision
• Survival Rate
• Adult

• Humans
• Stomach Neoplasms/surgery
• Stomach Neoplasms/mortality
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Postoperative Complications/mortality
• Body Mass Index
• Gastrectomy/adverse effects
• Thinness/complications
• Preoperative Period
• Overweight/complications
• Risk Factors

• gastrectomy
• gastric cancer
• prognostic factors
• risk factor
• survival after surgery

• Postoperative complication
• Stomach neoplasms
• Tumor recurrence

• Gastrectomy
• Gastric cancer
• Meta-analysis
• Obesity
• Postoperative outcomes

The impact of microsatellite status on lymph node (LN) yield during lymphadenectomy and pathological examination has never been assessed in gastric cancer (GC). In this study, we aimed to appraise the association between microsatellite instability-high (MSI-H) and LN yield after curative gastrectomy.

We retrospectively analyzed 1757 patients with GC undergoing curative gastrectomy and divided them into two groups: MSI-H (n = 185(10.5%)) and microsatellite stability (MSS) (n = 1572(89.5%)), using a five-Bethesda-marker (NR-24, BAT-25, BAT-26, CAT-25, MONO-27) panel. The median LN count and the percentage of specimens with a minimum of 16 LNs (adequate LN ratio) were compared between the two groups. The log odds (LODDS) of positive LN count (PLNC) to negative LN count (NLNC) and the target LN examined threshold (TLNT_(x%)) were calculated in both groups.

Statistically significant differences were found in the median LN count between MSI-H and MSS groups for the complete cohort (30 vs. 28, p = 0.031), for patients undergoing distal gastrectomy (DG) (30 vs. 27, p = 0.002), for stage II patients undergoing DG (34 vs. 28, p = 0.005), and for LN-negative patients undergoing DG (28 vs. 24, p = 0.002). MSI-H was an independent factor for higher total LN count in patients undergoing DG (p = 0.011), but it was not statistically correlated to the adequate LN ratio. Statistically significant differences in PLNC, NLNC and LODDS were found between MSI-H GC and MSS GC (all p < 0.001). The TLNT_(90%) for MSI-H and MSS groups were 31 and 25, respectively. TLNT_(X%) of MSI-H GC was always higher than that of MSS GC regardless of the given value of X%.

MSI-H was associated with higher LN yield in patients undergoing gastrectomy for GC. Although MSI-H did not affect the adequacy of LN harvest, we speculate that a greater lymph node yield is required during pathological examination in MSI-H GC.

• Gastric cancer
• Lymph node count
• Microsatellite instability

• Body mass index
• Gastric cancer
• Malnutrition
• Obesity
• Survival benefit

• Body mass index
• Gastric cancer
• Prognosis
• Signet ring cell carcinoma

• Adenocarcinoma/mortality
• Adenocarcinoma/pathology
• Adenocarcinoma/surgery
• Body Mass Index
• Carcinoma, Signet Ring Cell/mortality
• Carcinoma, Signet Ring Cell/pathology
• Carcinoma, Signet Ring Cell/surgery
• Female
• Gastrectomy/methods
• Humans
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Survival Rate

The effect of obesity on response to neoadjuvant chemotherapy (NACT) remains unknown. We aimed to investigate the effect of obesity on response to NACT and survival in locally-advanced gastric cancer (GC).

From 2010 to 2019, 142 GC patients with clinical stage III disease who underwent curative surgery after NACT were enrolled. Patients were divided into 3 groups according to body mass index (BMI) as follows; BMI < 25 kg/m², BMI = 25-30 kg/m², and BMI > 30 kg/m². The Mandard tumor regression grading system was used for tumor regression grade (TRG).

Of the 142 GC patients, 45(31.7%) were female. The median age was 58 years. BMI was < 25 kg/m² in 60 (42.3%) patients, 25-30 kg/m2 in 44 (31%) patients, and > 30kg/m² in 38 (26.8%) patients. The numbers of patients with TRGI-II, TRGIII, and TRGIV-V were 35 (24.6%), 44 (31%), and 63 (44.4%), respectively. There was no statistically significant difference among BMI groups in terms of disease-free survival (DFS) and overall survival (OS) (p = 0.919 and p = 0.398, respectively). According to TRG groups; mDFS was 46 months in TRG I-II, 28 months in TRG III, and 18 months in TRG IV-V (p<0.001). In multivariate analysis, presence of perineural invasion and lymphovascular invasion were the factors affecting TRG.

In our study, we found that pre-treatment obesity did not affect the TRG in clinical stage III GC patients. However, a better TRG status was associated with improved survival.

• Body mass index
• Gastric cancer
• Obesity
• tumor regression grade

Lifestyle factors such as body mass index (BMI), alcohol drinking, and cigarette smoking, are likely to impact the prognosis of gastric cancer, but the evidence has been inconsistent.

To investigate the association of lifestyle factors and long-term prognosis of gastric cancer patients in the China National Cancer Center.

Patients with gastric cancer were identified from the China National Cancer Center Gastric Cancer Database 1998-2018. Survival analysis was performed via Kaplan-Meier estimates and Cox proportional hazards models.

In this study, we reviewed 18441 cases of gastric cancer. Individuals who were overweight or obese were associated with a positive smoking and drinking history (P = 0.002 and P < 0.001, respectively). Current smokers were more likely to be current alcohol drinkers (61.3% vs 10.1% vs 43.2% for current, never, and former smokers, respectively, P < 0.001). Multivariable results indicated that BMI at diagnosis had no significant effect on prognosis. In gastrectomy patients, factors independently associated with poor survival included older age (HR = 1.20, 95%CI: 1.05-1.38, P = 0.001), any weight loss (P < 0.001), smoking history of more than 30 years (HR = 1.14, 95%CI: 1.04-1.24, P = 0.004), and increasing pTNM stage (P < 0.001).

In conclusion, our results contribute to a better understanding of lifestyle factors on the overall burden of gastric cancer and long-term prognosis. In these patients, weight loss (both in the 0 to 10% and > 10% groups) but not BMI at diagnosis was related to survival outcomes. With regard to other factors, smoking history of more than 30 years conferred a worse prognosis only in patients who underwent gastrectomy. Extensive efforts are needed to elucidate mechanisms targeting the complex effects of lifestyle factors.

• Gastric cancer
• Lifestyle factors
• Prognosis
• Cohort study
• Body mass index
• Cigarette smoking

• Adult
• Age Factors
• Aged
• Alcohol Drinking/epidemiology
• Body Mass Index
• Chemotherapy, Adjuvant/statistics & numerical data
• China/epidemiology
• Female
• Follow-Up Studies
• Gastrectomy/statistics & numerical data
• Humans
• Kaplan-Meier Estimate
• Life Style
• Male
• Middle Aged
• Neoadjuvant Therapy/statistics & numerical data
• Neoplasm Staging
• Obesity/epidemiology
• Overweight/epidemiology
• Prognosis
• Retrospective Studies
• Risk Factors
• Smoking/epidemiology
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Stomach Neoplasms/therapy
• Weight Loss

• Body mass index
• Linxian dysplasia population
• Prospective study
• Trial cohort
• Upper gastrointestinal cancer

• Adult
• Aged
• Body Mass Index
• Cohort Studies
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prospective Studies
• Risk
• Stomach Neoplasms/diet therapy
• Stomach Neoplasms/pathology
• Time Factors

• HHSN261201700047C NCI NIH HHS
• Z01 CP000112 Intramural NIH HHS

• D2 dissection
• Extended lymphadenectomy
• Gastric cancer
• Two-step technique

• Body mass index (BMI)
• Gastrectomy
• Gastric cancer
• Obesity
• Overweight
• Postoperative complications
• Prognosis

The association between body mass index (BMI) and clinical outcomes of gastric cancer were still under debate. The aim of the present study was to investigate the impact of BMI on intraoperative conditions, postoperative complications and prognosis of gastric cancer.

From October 2008 to March 2015, 1210 gastric cancer patients treated with D2 gastrectomy were enrolled in the present study. Patients were divided into three groups: low BMI group (BMI < 18.5 Kg/m²), normal BMI group (18.5 Kg/m² ≤ BMI < 25.0 Kg/m²) and high BMI group (BMI ≥ 25.0 Kg/m²). Clinicopathological characteristics and prognosis of patients were recorded and analyzed. Propensity score matching was used to match patients in the three groups.

There were 107 patients in low BMI group (8.9%), 862 patients in normal BMI group (71.2%) and 241 patients in high BMI group (19.95%). Before matching, BMI was inversely associated with tumor size, tumor depth, lymph node metastasis (LNM) and tumor stage (all P < 0.05). After matching, the clinicopathological features were all comparable among the three groups (all P > 0.05). High BMI was associated with increased blood loss and operation time, and deceased number of retrieved lymph nodes (all P < 0.05). For postoperative complications, low BMI was associated with decreased rate of postoperative fever (P = 0.025). Age, BMI, tumor size, Borrmann type, pathological type, type of gastrectomy, tumor depth, LNM and tumor stage were risk factors for the prognosis of gastric cancer. Multivariate analysis showed that only BMI, tumor size, tumor depth and LNM were independent prognostic factors. The overall survival of patients with low BMI was significantly worse than patients with normal (P < 0.05) or high BMI (P < 0.05). However, the overall survival was comparable between patients with normal and high BMI (P > 0.05).

BMI was inversely associated with tumor size, tumor depth, LNM and tumor stage. High BMI was associated with increased blood loss and operation time, and deceased number of retrieved lymph nodes. Low BMI was associated with decreased rate of postoperative fever and decreased survival.

• BMI
• Complications
• Gastric cancer
• Prognosis

• adenocarcinoma of esophagogastric junction
• body mass index
• cancer-specific survival
• gastric cancer
• prospective cohort study

Clinical trials comparing laparoscopic gastrectomy (LG) versus traditional open gastrectomy (OG) have been planned, their surgical outcomes reported but their oncologic outcomes are still pending. Consequently, we have conducted this large-scale historical cohort study to provide relevant information rapidly to guide our current practice.

Through a consensus meeting involving surgeons, biostatisticians, and epidemiologists, 30 variables of preoperative information possibly influencing surgeons’ choice between LG versus OG and potentially associating with outcomes were identified to enable rigorous estimation of propensity scores. A total of 4235 consecutive patients who underwent gastrectomy for gastric adenocarcinoma were identified and their relevant data were gathered from the participating hospitals. After propensity score matching, 1848 patients (924 each for LG and OG) were selected for comparison of long-term outcomes.

In the propensity-matched population, the 5-year overall survival was 96.3% [95% confidence interval (CI) 95.0–97.6] in the OG as compared with 97.1% (95% CI, 95.9–98.3) in LG. The number of all-cause death was 33/924 in the OG and 24/924 in the LG through the entire period, and the hazard ratio (LG/OG) for overall death was 0.75 (95% CI, 0.44–1.27; P = 0.290). The 3-year recurrence-free survival was 97.4% (95% CI, 96.4–98.5) in the OG and 97.7% (95% CI, 96.5–98.8) in the LG. The number of recurrence was 22/924 in the OG and 21/924 in the LG through the entire period, and the hazard ratio was 1.01 (95% CI, 0.55–1.84; P = 0.981).

This observational study adjusted for all-known confounding factors seems to provide strong enough evidence to suggest that LG is oncologically comparable to OG for gastric cancer.

• Gastric cancer
• Intraoperative fluid
• Perioperative outcomes

• BMI
• Hospital-acquired infection

• Body Mass Index
• Digestive System Surgical Procedures/adverse effects
• Female
• Humans
• Incidence
• Male
• Pneumonia/epidemiology
• Pneumonia/mortality
• Risk Assessment
• Surgical Wound Infection/epidemiology
• Surgical Wound Infection/mortality
• Survival Analysis
• Urinary Tract Infections/epidemiology
• Urinary Tract Infections/mortality

• Adult
• Aged
• Aged, 80 and over
• Body Mass Index
• Cohort Studies
• Female
• Gastrectomy
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Postoperative Complications/epidemiology
• Stomach Neoplasms/mortality
• Stomach Neoplasms/surgery
• Treatment Outcome