Background: Oesophageal and gastric cancer is associated with the highest rates of malnutrition amongst all types of malignancies. Preliminary research indicates that nutritional status is predictive of overall survival in patients with upper gastrointestinal cancer. The aim of this study is to investigate the prognostic significance of malnutrition and inflammatory markers on overall survival (OS) and progression-free survival (PFS).
Methods: We performed a retrospective cohort study of 127 participants with oesophageal and gastric adenocarcinoma who underwent treatment in the Illawarra Shoalhaven Local Health District between August 2013 and September 2021. The Patient Generated Subjective Global Assessment (PG-SGA) was used to assess malnutrition before and after surgery. The Prognostic Nutritional Index (PNI) was calculated from preoperative serum albumin and total lymphocyte count. OS and PFS were evaluated with Kaplan Meier and Cox proportional hazards model.
Results: The prevalence of malnutrition significantly increased from 56.5% preoperatively to 84.5% postoperatively (p = 0.003). Preoperative tube feeding was significantly associated with improvement or maintenance of PG-SGA score (p = 0.015). The variables independently associated with OS in the multivariable analysis were postoperative malnutrition (Hazard Ratio [HR] 7.79, 95% confidence interval [CI] 1.03-59.08, p = 0.047) and PNI score (HR 0.91, 95% CI 0.85-0.98, p = 0.008). PFS was not associated with PG-SGA or PNI score.
Conclusion: Postoperative malnutrition and a low preoperative PNI score are associated with shorter survival time in oesophageal and gastric cancer. Preoperative nutritional intervention is warranted to preserve nutritional status and prevent postoperative malnutrition.