[Effect of neoadjuvant chemotherapy on nutritional status of locally advanced gastric cancer].

OBJECTIVE: To study the effect of neoadjuvant chemotherapy on nutritional status in patients with locally advanced gastric cancer.
METHODS: Cases inclusion criteria: (1)18-65 years old; (2) Gastric cancer confirmed by gastroscopic biopsy; (3) Preoperative TNM stage III( according to the AJCC stage 2000 standard; (4) Kamosfsky functional status score> 60 points; (5)Receiving neoadjuvant chemotherapy voluntarily and signing the informed consent form. Case exclusion criteria: (1)Having contraindications of chemotherapy and surgery; (2) Suffering from heart, liver and kidney and other underlying diseases; (3) Concurrent with malignant diseases, wasting disease or other digestive diseases. According to the above criteria, clinical data of 73 patients of stage III( gastric cancer receiving neoadjuvant chemotherapy at Weifang People's Hospital from May 2015 to March 2017 were prospectively collected. The cohort study was adopted. After removing 3 patients who did not complete the chemotherapy, a total of 70 patients who completed the chemotherapy were included in the study. All the patients received SOX chemotherapy without nutritional support during chemotherapy. Changes of body composition and nutritional indicators were analyzed before and after chemotherapy, and according to the tumor regression after chemotherapy, patients were divided into response group (complete or sub-total tumor regression) and non-response group (tumor part, with or without a small amount of retreat) for stratified analysis.
RESULTS: Of 70 gastric cancer patients, 40 were male and 30 were female with a age of (53.8±6.4) (28 to 64) years. There were 26 cases (37.1%) of stage III(a, 35 cases (50.0%) of stage III(b and 9 cases (12.9%) of stage III(c. There were 41 cases in response group and 29 cases in non-response group. Three patients (4.3%) were complete remission (CR) and 38 patients (54.3%) were partial remission (PR) in response group, while 23 cases (32.9%) were stable disease (SD) and 6 cases (8.6%) were progressive disease (PD). After neoadjuvant chemotherapy, the extracellular fluid of the whole patients increased from (13.3±1.7) L to (13.5±1.6) L (t=-2.044, P=0.045); the intracellular fluid decreased from (21.4±2.5) L to (21.1±2.4) L (t=2.369, P=0.021); the lymphocyte count decreased from (0.31±0.10)×109/L to (0.29±0.10)×109/L (t=1.706, P=0.009); the other indexes were not significantly different (all P>0.05). Stratified analysis showed that after neoadjuvant chemotherapy in response group, body mass increased from (60.1±8.8) kg to (61.0±8.3) kg (t=-2.773, P=0.008); body mass index increased from (21.9±2.4) kg/m2 to (22.3±1.9) kg/m2(t=-3.479, P=0.001), while above two parameters did not differ significantly in non-response group. No significant differences in body mass, body mass index, skeletal muscle, inorganic salt, extracellular fluid, body fat, protein, upper arm circumference and intracellular fluid were found between two groups before and after neoadjuvant chemotherapy(all P>0.05). Except slight decrease in hemoglobin and lymphocyte, the other nutritional indicators were slightly elevated in response group, while the differences were not statistically significant(all P>0.05). All nutritional indicators in non-response group were slightly decreased without significant differences as well (all P>0.05).
CONCLUSION: Neoadjuvant chemotherapy does not aggravate malnutrition in patients with locally advanced gastric cancer.