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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Impact of non-alcoholic hepatic steatosis on prognosis and clinical outcomes in gastric cancer patients undergoing laparoscopic distal gastrectomy
Yi-Fan Zou, Yi-Gang Zhang, Zi-Chu Zhao, Zheng Li, Hong-Da Liu, Qing-Ya Li, Ze-Tian Chen, Cheng-Jun Zhu, Hai-Tao Liu, Ji-Wei Wang, Feng-Yuan Li, Lin-Jun Wang, Dian-Cai Zhang, Li Yang, Hao Xu, Ze-Kuan Xu, Sen Wang
Yi-Fan Zou, Yi-Gang Zhang, Zheng Li, Hong-Da Liu, Qing-Ya Li, Ze-Tian Chen, Cheng-Jun Zhu, Hai-Tao Liu, Ji-Wei Wang, Feng-Yuan Li, Lin-Jun Wang, Dian-Cai Zhang, Li Yang, Hao Xu, Ze-Kuan Xu, Sen Wang, Gastric Cancer Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Yi-Fan Zou, Yi-Gang Zhang, Zheng Li, Hong-Da Liu, Qing-Ya Li, Ze-Tian Chen, Cheng-Jun Zhu, Hai-Tao Liu, Ji-Wei Wang, Feng-Yuan Li, Lin-Jun Wang, Dian-Cai Zhang, Li Yang, Hao Xu, Ze-Kuan Xu, Sen Wang, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Zi-Chu Zhao, The First Clinical College, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Ze-Kuan Xu, The Institute of Gastric Cancer, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Ze-Kuan Xu, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China
Co-first authors: Yi-Fan Zou and Yi-Gang Zhang.
Co-corresponding authors: Ze-Kuan Xu and Sen Wang.
Author contributions: Zou YF and Zhang YG were responsible for investigation, formal analysis and writing the original draft; Zou YF was responsible for the figure plotting, preparation and submission of the manuscript. Zhang YG search the literature and drafted the major part of the discussion section. Both co-first authors (Zou YF and Zhang YG) made substantial and indispensable contributions to the study. Zhao ZC revised and validated the conclusions. Li Z, Liu HD, Li FY, Wang LJ, Zhang DC, Yang L and Xu H provided the data resources of all clinical samples; Li QY was mainly responsible for patient follow-up and data curation; Chen ZT, Zhu CJ, Liu HT and Wang JW reviewed and validated all data and results; Both Xu ZK and Wang S, who were co-corresponding authors in the current study, conceptualized the study and supervised all procedures during the implementation of the research. Xu ZK focuses on the perioperative management of patients receiving gastrectomy based on personalized risk stratification. Considering that NAFLD is a risk factor for gastric cancer, he thought whether patients with or without NAFLD would have distinct clinical outcomes, which made him launch this study. Wang S acquired the funding for the study, which ensured the research could be developed smoothly. Both co-corresponding authors (Xu ZK and Wang S) were crucial for the implementation and final publication of this manuscript.
Supported by China Postdoctoral Science Foundation, No. 2021TQ0132; and The Youth Fund Program for National Natural Science Foundation of China from the First Affiliated Hospital of Nanjing Medical University, No. PY2021032.
Institutional review board statement: This investigation was approved by the Institutional Ethics Committee of Nanjing Medical University.
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The original data used in the study will be shared upon reasonable request at
wangsen199206@qq.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Sen Wang, MD, PhD, Gastric Cancer Center, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Gulou District, Nanjing 210029, Jiangsu Province, China.
wangsen199206@qq.com
Received: February 19, 2025
Revised: April 12, 2025
Accepted: July 21, 2025
Published online: September 27, 2025
Processing time: 217 Days and 20.8 Hours
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized for its role in the pathogenesis of various cancers. However, its impact on gastric cancer (GC) outcomes, particularly in patients undergoing laparoscopic distal gastrectomy (LDG), remains unclear.
AIM
To investigate the clinical and prognostic impacts of NAFLD on GC patients undergoing LDG.
METHODS
In this retrospective cohort study, we collected clinical data from 1122 GC patients who underwent LDG at the Gastric Cancer Center of the First Affiliated Hospital of Nanjing Medical University between January 2020 and December 2022. Propensity score-matching (PSM) was used to mitigate the bias to compare the oncological and surgical outcomes between the two groups. Survival analysis was also performed to evaluate NAFLD as a prognostic factor.
RESULTS
PSM yielded a balanced cohort of 260 patients (52 with NAFLD and 208 controls) from the original cohort. No differences in clinicopathological characteristics, including surgery time, complications, T stage, N stage, p-tumor-node-metastasis stage, neural invasion, vascular invasion, total number of retrieved lymph nodes, positive retrieved lymph nodes and positive lymph nodes rate, were observed between the two groups. Overall survival was comparable between two groups (Log-rank P = 0.49), whereas progression-free survival (PFS) in the NAFLD group was inferior to that in the control group (Log-rank P = 0.016). Univariable Cox regression analysis further confirmed that NAFLD was an unfavorable prognostic factor for PFS.
CONCLUSION
GC patients with NAFLD exhibited inferior PFS, suggesting that addressing NAFLD-related metabolic alterations may enhance clinical outcomes. Future investigations should explore the mechanistic links between NAFLD and GC progression and consider integrated therapeutic strategies.
Core Tip: This is a retrospective single-center observational study to investigate the potential impacts of Non-alcoholic fatty liver disease (NAFLD) on gastric cancer (GC) patients receiving laparoscopic distal gastrectomy. Propensity score-matching analysis was utilized to generate a balanced cohort and we observed no difference in major clinicopathological characteristics between GC patients with and without NAFLD. Moreover, survival analysis indicated that GC patients with hepatic steatosis experience inferior progression-free survival (PFS) compared with those without NAFLD. In summary, NAFLD is a predictive factor of PFS and could be further employed in the clinical management of GC.
