Ji-Hyeon Park1, Eunjung Kim2,3, Eun-Mi Seol2,3, Seong-Ho Kong1,4, Do Joong Park1,4,5, Han-Kwang Yang1,4,5, Jong-Ho Choi1, Shin-Hoo Park6, Hwi-Nyeong Choe3, Meera Kweon7, Jiwon Park8, Yunhee Choi8, Hyuk-Joon Lee9,10,11. 1. Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. 2. Nutritional Support Team, Seoul National University Hospital, Seoul, Korea. 3. Department of Nursing, Seoul National University Hospital, Seoul, Korea. 4. Seoul National University College of Medicine, Seoul, Korea. 5. Cancer Research Institute, Seoul National University, Seoul, Korea. 6. Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea. 7. Departments of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea. 8. Department of Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea. 9. Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. appe98@snu.ac.kr. 10. Seoul National University College of Medicine, Seoul, Korea. appe98@snu.ac.kr. 11. Cancer Research Institute, Seoul National University, Seoul, Korea. appe98@snu.ac.kr.
Abstract
BACKGROUND: Malnutrition after gastrectomy is associated with a poor prognosis; however, no accurate model for predicting post-gastrectomy malnutrition exists. Hence, we conducted a retrospective study to develop a prediction model identifying gastric cancer patients at high risk of malnutrition after gastrectomy. METHOD: Gastric cancer patients who underwent curative gastrectomy with more than one weight measurement during a 3-year follow-up period were included. Malnutrition was defined as body mass index (BMI) < 18.5 kg/m2 according to the European Society of Clinical Nutrition and Metabolism diagnostic criteria. BMI-loss pattern was analyzed using a group-based trajectory model. A prediction model for malnutrition 6 months after gastrectomy was developed based on significant risk factors, and then validated. RESULTS: Overall, 1421 patients were examined. The BMI-loss trajectory model showed significant BMI loss at 6 months after gastrectomy. Severe BMI loss (mean 21.5%; n = 109) was significantly associated with the elderly, female sex, higher preoperative BMI, advanced cancer stage, open surgery, total gastrectomy, Roux-en-Y reconstruction, chemotherapy, and postoperative complications (all p < 0.05). Malnutrition 6 months after gastrectomy was observed in 152 (11.9%) of 1281 patients. Preoperative BMI, sex, and type of operation were included in the final prediction model as predictive factors (p < 0.05). The C-index of the developmental set and bootstrap validation of the prediction model was 0.91 (95% confidence interval 0.89-0.94) and 0.91, respectively. CONCLUSION: The prediction model for the risk of malnutrition 6 months after gastrectomy was accurately developed, with three independent risk factors: low preoperative BMI, female sex, and total or proximal gastrectomy.
BACKGROUND:Malnutrition after gastrectomy is associated with a poor prognosis; however, no accurate model for predicting post-gastrectomy malnutrition exists. Hence, we conducted a retrospective study to develop a prediction model identifying gastric cancerpatients at high risk of malnutrition after gastrectomy. METHOD:Gastric cancerpatients who underwent curative gastrectomy with more than one weight measurement during a 3-year follow-up period were included. Malnutrition was defined as body mass index (BMI) < 18.5 kg/m2 according to the European Society of Clinical Nutrition and Metabolism diagnostic criteria. BMI-loss pattern was analyzed using a group-based trajectory model. A prediction model for malnutrition 6 months after gastrectomy was developed based on significant risk factors, and then validated. RESULTS: Overall, 1421 patients were examined. The BMI-loss trajectory model showed significant BMI loss at 6 months after gastrectomy. Severe BMI loss (mean 21.5%; n = 109) was significantly associated with the elderly, female sex, higher preoperative BMI, advanced cancer stage, open surgery, total gastrectomy, Roux-en-Y reconstruction, chemotherapy, and postoperative complications (all p < 0.05). Malnutrition 6 months after gastrectomy was observed in 152 (11.9%) of 1281 patients. Preoperative BMI, sex, and type of operation were included in the final prediction model as predictive factors (p < 0.05). The C-index of the developmental set and bootstrap validation of the prediction model was 0.91 (95% confidence interval 0.89-0.94) and 0.91, respectively. CONCLUSION: The prediction model for the risk of malnutrition 6 months after gastrectomy was accurately developed, with three independent risk factors: low preoperative BMI, female sex, and total or proximal gastrectomy.
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