Impact of non-alcoholic hepatic steatosis on prognosis and clinical outcomes in gastric cancer patients undergoing laparoscopic distal gastrectomy

doi:10.4240/wjgs.v17.i9.106198

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Surg. Sep 27, 2025; 17(9): 106198
Published online Sep 27, 2025. doi: 10.4240/wjgs.v17.i9.106198

Table 1 Baseline characteristics before and after propensity score-matching, n (%)

Variables	Before PSM				After PSM
Variables	NAFLD (n = 52)	Controls (n = 1070)	P value	SMD	NAFLD (n = 52)	Controls (n = 208)	P value	SMD
Age (years)	59.9 (13.9)	60.2 (11.1)	0.828	0.027	59.9 (13.9)	59.4 (11.0)	0.784	0.039
≤ 60	30 (57.7)	518 (48.4)			30 (57.7)	111 (53.4)
> 60	22 (42.3)	552 (51.6)			22 (42.3)	97 (46.6)
Gender			0.444	0.128			0.724	0.079
Male	31 (59.6)	704 (65.8)			31 (59.6)	132 (63.5)
Female	21 (40.4)	366 (34.2)			21 (40.4)	76 (36.5)
BMI	26.6 (3.0)	23.5 (3.1)	< 0.001^a	1.046	26.6 (3.0)	23.9 (3.1)	< 0.001^a	0.896
≤ 28	37	987			37	190
> 28	15	83			15	18
Preoperative CEA (ng/mL)	2.8 (4.0)	3.7 (9.8)	0.484	0.128	2.8 (4.0)	2.8 (4.3)	0.996	0.001
≤ 5	46 (88.5)	952 (89.0)			46 (88.5)	190 (91.3)
> 5	6 (11.5)	118 (11.0)			6 (11.5)	18 (8.7)
Preoperative CA724 (µg/L)	3.4 (4.0)	5.7 (19.2)	0.405	0.165	3.4 (4.0)	4.0 (8.5)	0.619	0.094
≤ 6.7	41 (78.8)	881 (82.3)			41 (78.8)	172 (82.7)
> 6.7	8 (15.4)	135 (12.6)			8 (15.4)	21 (10.1)
Preoperative CA199 (U/mL)	17.0 (29.2)	24.3 (88.7)	0.554	0.111	17.0 (29.2)	18.7 (74.6)	0.866	0.032
≤ 37	49 (94.2)	993 (92.8)			49 (94.2)	201 (96.6)
> 37	3 (5.8)	77 (7.2)			3 (5.8)	7 (3.4)

^aP < 0.05, statistically significant.

NAFLD: Non-alcoholic fatty liver disease; BMI: Body mass index; PSM: Propensity score-matching; SMD: standardized mean difference.

Full Size Table

Table 2 Clinicopathological characteristics before and after propensity score-matching adjusting for major clinical parameters including sex, age, pathological T stage, pathological N stage, reconstructive techniques and laparoscopic approach

Variables	Before PSM				After PSM
Variables	NAFLD (n = 52)	Controls (n = 1070)	P value	SMD	NAFLD (n = 52)	Controls (n = 208)	P value	SMD
Surgery time (minutes), mean (SD)	198.9 (52.7)	189.2 (46.5)	0.144	0.195	198.9 (52.7)	194.6 (47.1)	0.704	0.087
Complication			0.927	0.046			0.608	0.121
Yes (%)	5 (9.6)	118 (11.0)			5 (9.6)	28 (13.5)
No (%)	47 (90.3)	952 (89.0)			47 (90.3)	180 (86.5)
Complication (Grade III to V)			1	0.053			1	0.053
Yes (%)	2 (3.8)	31 (2.9)			2 (3.8)	6 (2.9)
No (%)	50 (96.2)	1039 (97.1)			50 (96.2)	202 (97.1)
T stage			0.438	0.383			0.886	0.171
T1 (%)	32 (61.5)	540 (50.5)			32 (61.5)	126 (60.6)
T2-3 (%)	11 (21.1)	370 (34.6)			11 (21.1)	48 (23.1)
T4 (%)	9 (17.3)	160 (15.0)			9 (17.3)	34 (16.3)
N stage			0.028^a	0.531			0.809	0.176
N0 (%)	38 (73.1)	587 (54.9)			38 (73.1)	152 (73.1)
N1-2 (%)	7 (13.5)	288 (26.9)			7 (13.5)	30 (14.4)
N3 (%)	7 (13.4)	195 (18.2)			7 (13.4)	26 (12.5)
pTNM stage (AJCC 8th)			0.123	0.502			0.846	0.251
I A-B (%)	34 (65.4)	564 (52.7)			34 (65.4)	142 (68.3)
II A-B (%)	8 (15.4)	219 (20.5)			8 (15.4)	32 (15.4)
III A-C (%)	10 (19.2)	287 (26.8)			10 (19.2)	34 (16.3)
Neural invasion			0.067	0.306			0.521	0.133
Yes (%)	9 (17.3)	323 (30.2)			9 (17.3)	47 (22.6)
No (%)	43 (82.7)	747 (69.8)			43 (82.7)	161 (77.4)
Vascular invasion			0.687	0.080			0.479	0.135
Yes (%)	14 (26.9)	327 (30.6)			14 (26.9)	44 (21.2)
No (%)	38 (73.1)	743 (69.4)			38 (73.1)	164 (78.8)
Retrieved lymph nodes [mean (SD)]	39.2 (12.3)	42.5 (11.1)	0.040^a	0.279	39.2 (12.3)	42.5 (12.5)	0.058	0.271
Positive lymph nodes [mean (SD)]	3.4 (8.8)	3.27 (6.1)	0.868	0.020	3.4 (8.8)	3.0 (7.0)	0.949	0.058
Positive lymph nodes rate [mean (SD)]	0.56 (1.04)	0.79 (1.02)	0.112	0.224	0.56 (1.04)	0.55 (1.02)	0.992	0.005

^aP < 0.05, statistically significant.

NAFLD: Non-alcoholic fatty liver disease; PSM: Propensity score-matching; SMD: standardized mean difference.

Full Size Table

Table 3 Univariable Cox regression model for overall survival and progression-free survival in the propensity score-matched samples

Variables	Overall survival		Progression-free survival
Variables	HR (95%CI)	P value	HR (95%CI)	P value
NAFLD yes vs no	0.60 (0.13-2.64)	0.496	2.56 (1.16-5.64)	0.02^a
FIB-4 score	1.52 (1.02-2.31)	0.04^a	1.31 (0.91-1.89)	0.144
Age	1.07 (1.02-1.12)	0.007^a	1.06 (1.02-1.09)	0.003^a
Sex Male vs Female	0.39 (0.14-1.08)	0.07	0.36 (0.16-0.80)	0.001^a
BMI	0.90 (0.76-1.06)	0.21	1.07 (0.96-1.2)	0.223
T stage T1-T2 vs T3-4	0.05 (0.01-0.21)	6.71 × 10^-5^a	0.07 (0.03-0.18)	7.47 × 10^-8^a
N stage N0-1 vs N2-3	0.08 (0.03-0.25)	1.53 × 10^-5^a	0.10 (0.05-0.23)	4.29 × 10^-8^a
Stage I-II vs III	0.06 (0.02-0.20)	2.6 × 10^-6^a	0.08 (0.04-0.18)	1.37 × 10^-9^a
Vascular invasion yes vs no	4.2 (1.52-11.6)	0.006	2.3 (1.05-5.08)	0.038
Neural invasion yes vs no	5.94 (2.11-16.7)	7.23 × 10^-4^a	4.08 (1.89-8.81)	3.44 × 10^-4^a
Total retrieved lymph node	1.00 (0.96-1.04)	0.852	0.99 (0.96-1.02)	0.529
Positive lymph node	1.11 (1.07-1.14)	5.28 × 10^-10^a	1.10 (1.07-1.13)	9.73 × 10^-13^a
Positive lymph node rate	2.86 (1.88-4.36)	9.01 × 10^-7^a	2.56 (1.9-3.45)	6.98 × 10^-10^a

^aP < 0.05, statistically significant.

NAFLD: Non-alcoholic fatty liver disease; BMI: Body mass index.

Full Size Table

Citation: Zou YF, Zhang YG, Zhao ZC, Li Z, Liu HD, Li QY, Chen ZT, Zhu CJ, Liu HT, Wang JW, Li FY, Wang LJ, Zhang DC, Yang L, Xu H, Xu ZK, Wang S. Impact of non-alcoholic hepatic steatosis on prognosis and clinical outcomes in gastric cancer patients undergoing laparoscopic distal gastrectomy. World J Gastrointest Surg 2025; 17(9): 106198
URL: https://www.wjgnet.com/1948-9366/full/v17/i9/106198.htm
DOI: https://dx.doi.org/10.4240/wjgs.v17.i9.106198