CT-based Fat Distribution-Informed Reinterpretation of BMI for Disease-Weighted Nutritional Risk Classification in...

Area of Science:

• Oncology
• Gastroenterology
• Metabolic Medicine

Background:

• Prognosis in locally advanced gastric cancer (LAGC) is influenced by nutritional status, but current staging lacks assessment of treatment-related changes.
• Neoadjuvant chemotherapy (NACT) can alter nutritional and metabolic status, impacting patient outcomes.
• Existing staging systems do not fully capture prognostic information related to nutritional status during NACT.

Purpose of the Study:

• To develop and validate a novel prognostic classification integrating nutritional-metabolic status with tumor burden for LAGC patients.
• To assess the performance of this new classification against the current AJCC staging system.

Main Methods:

• Retrospective analysis of 643 LAGC patients undergoing NACT and curative gastrectomy.
• Development of a sex-specific Nutritional Risk Score Scale (NRSS) using baseline BMI and changes in visceral-to-subcutaneous adipose ratio (ΔVSR).
• Creation of an integrated NRSS-ypN classification (Grades I-IV) and comparison with AJCC 8th ypTNM staging.

Main Results:

• Higher NRSS stages correlated with significantly worse overall survival (OS) and disease-free survival (DFS).
• Both NRSS and ypN stage were identified as independent prognostic factors.
• The NRSS-ypN classification showed superior prognostic discrimination compared to AJCC 8th ypTNM staging (C-index for OS: 0.715 vs. 0.693).
• 3-year OS rates varied significantly across NRSS-ypN Grades I-IV (87.9% to 29.5%).

Conclusions:

• The NRSS-ypN classification effectively integrates nutritional-metabolic status and tumor burden.
• This novel classification improves postoperative risk stratification for LAGC patients receiving neoadjuvant therapy.
• The findings suggest a potential refinement of staging systems for gastric cancer treatment planning.