Improvement of Body Weight and Nutritional Status in Gastric Cancer Patients Enhances the Benefit of Nivolumab Therapy

Ikoma, Tatsuki; Matsumoto, Toshihiko; Kurioka, Yusuke; Takatani, Masahiro; Nagai, Hiroki; Matsumoto, Yusuke; Satake, Hironaga; Yasui, Hisateru

doi:10.3390/jcm11206100

Cited by 3 publications

(5 citation statements)

References 18 publications

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“… 34 Additionally, early intervention to maintain body weight and nutritional status may improve the efficacy of immune checkpoint inhibitors in patients with gastric cancer. 35 Our observations partially align with this report, showing that peridiagnosis weight gain is protective for survival. However, weight gain, especially significant weight gain, 34 can also be a risk factor for OS.…”

Section: Discussionsupporting

confidence: 90%

“…A previous study showed that patients with prediagnosis or postdiagnosis weight gain generally have better outcomes compared with those who experienced weight loss 34 . Additionally, early intervention to maintain body weight and nutritional status may improve the efficacy of immune checkpoint inhibitors in patients with gastric cancer 35 . Our observations partially align with this report, showing that peridiagnosis weight gain is protective for survival.…”

Section: Discussionsupporting

confidence: 88%

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Exploring the optimal indicator of short‐term peridiagnosis weight dynamics to predict cancer survival: A multicentre cohort study

Yin,

Zhang,

et al. 2024

J cachexia sarcopenia muscle

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BackgroundBody weight and its changes have been associated with cancer outcomes. However, the associations of short‐term peridiagnosis weight dynamics in standardized, clinically operational time frames with cancer survival remain largely unknown. This study aimed to screen for and evaluate the optimal indicator of short‐term peridiagnosis weight dynamics to predict overall survival (OS) in patients with cancer.MethodsThis multicentre cohort study prospectively collected data from 7460 patients pathologically diagnosed with cancer between 2013 and 2019. Body weight data were recorded 1 month before, at the time of and 1 month following diagnosis. By permuting different types (point value in kg, point height‐adjusted value in kg/m2, absolute change in kg or relative change in percentage) and time frames (prediagnosis, postdiagnosis or peridiagnosis), we generated 12 different weight‐related indicators and compared their prognostic performance using Harrell's C‐index, integrated discrimination improvement, continuous net reclassification improvement and time‐dependent C‐index. We analysed associations of peridiagnosis relative weight change (RWC) with OS using restricted cubic spine (RCS), Kaplan–Meier analysis and multivariable‐adjusted Cox regression models.ResultsThe study enrolled 5012 males and 2448 females, with a median age of 59 years. During a median follow‐up of 37 months, 1026 deaths occurred. Peridiagnosis (1 month before diagnosis to 1 month following diagnosis) RWC showed higher prognostic performance (Harrell's C‐index = 0.601, 95% confidence interval [CI] = [0.583, 0.619]) than other types of indicators including body mass index (BMI), absolute weight change, absolute BMI change, prediagnosis RWC and postdiagnosis RWC in the study population (all P < 0.05). Time‐dependent C‐index analysis also indicated that peridiagnosis RWC was optimal for predicting OS. The multivariable‐adjusted RCS analysis revealed an N‐shaped non‐linear association between peridiagnosis RWC and OS (PRWC < 0.001, Pnon‐linear < 0.001). Univariate survival analysis showed that the peridiagnosis RWC groups could represent distinct mortality risk stratifications (P < 0.001). Multivariable survival analysis showed that, compared with the maintenance group (weight change < 5%), the significant (gain >10%, hazard ratio [HR] = 0.530, 95% CI = [0.413, 0.680]) and moderate (gain 5–10%, HR = 0.588, 95% CI = [0.422, 0.819]) weight gain groups were both associated with improved OS. In contrast, the moderate (loss 5–10%, HR = 1.219, 95% CI = [1.029, 1.443]) and significant (loss >10%, HR = 1.280, 95% CI = [1.095, 1.497]) weight loss groups were both associated with poorer OS.ConclusionsThe prognostic performance of peridiagnosis RWC is superior to other weight‐related indicators in patients with cancer. The findings underscore the importance of expanding the surveillance of body weight from at diagnosis to both past and future, and conducting it within clinically operational time frames, in order to identify and intervene with patients who are at risk of weight change‐related premature deaths.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

Exploring the optimal indicator of short‐term peridiagnosis weight dynamics to predict cancer survival: A multicentre cohort study

Yin,

Zhang,

et al. 2024

J cachexia sarcopenia muscle

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“…Furthermore, a retrospective multi-center study of 97 patients with unresectable or recurrent GC who received nivolumab showed that the median OS was significantly shorter in the group with high changes in CAR from first-line chemotherapy (ΔCAR) than in the group with low ΔCAR (4.5 months vs. 9.4 months, p = 0.002). On multivariate analysis, low ΔCAR was an independent prognostic factor of OS (HR, 0.67; 95% CI, 0.35–0.91, p = 0.02) [ 19 ]. Considering the clinical application of CAR in patients with mGC/EGJC treated with FTD/TPI, using CAR as a prognostic predictor for patients with mGC/EGJC may be a factor in the decision to transition to the next line of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Peri-treatment inflammatory and nutritional status are attracting attention as prognostic factors for patients with cancer [ 16 , 17 ]. Several studies have shown that the C-reactive protein/serum albumin ratio (CAR), which reflects the host’s inflammatory and nutritional status, is a useful prognostic marker in pre-treatment blood testing [ 18 , 19 ]. However, the quest to identify prognostic factors in patients with mGC/GEJC treated with FTD/TPI remain insufficient.…”

Section: Introductionmentioning

confidence: 99%

Clinical Effect of the C-Reactive Protein to Serum Albumin Ratio in Patients with Metastatic Gastric or Gastroesophageal Junction Cancer Treated with Trifluridine/Tipiracil

Hashimoto

Kano

Onuma

et al. 2023

JPM

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Trifluridine/tipiracil (FTD/TPI) is an oral anticancer agent used as a third- or later-line treatment for patients with metastatic gastric cancer/gastroesophageal junction cancer (mGC/GEJC). The C-reactive protein-to-serum albumin ratio (CAR) is an inflammation-based prognostic marker in gastric cancer. This retrospective study evaluated CAR’s clinical significance as a prognostic factor in 64 patients with mGC/GEJC administered FTD/TPI as a third- or later-line therapy. Patients were categorized into high- and low-CAR groups based on pre-treatment blood data. This study evaluated associations between CAR and overall survival (OS), progression-free survival (PFS), clinicopathological features, treatment efficacy, and adverse events. The high-CAR group had significantly worse Eastern Cooperative Oncology Group performance status, a higher prevalence of patients administered with a single course of FTD/TPI, and a higher rate of patients not administered chemotherapy after FTD/TPI therapy than the low-CAR group. Median OS and PFS were significantly poorer in the high-CAR group than in the low-CAR group (113 vs. 399 days; p < 0.001 and 39 vs. 112 days; p < 0.001, respectively). In multivariate analysis, high CAR was an independent prognostic factor for OS and PFS. The overall response rate was not significantly different between the high- and low-CAR groups. Regarding adverse events, the high-CAR group had a significantly lower incidence of neutropenia and a higher incidence of fatigue than the low-CAR group. Therefore, CAR may be a potentially useful prognostic factor for patients with mGC/GEJC treated with FTD/TPI as third- or later-line chemotherapy.

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“…In addition, change in CAR after chemoradiation therapy were a prognostic factor (hazard ratio: 5.1842, p = 0.0036). Moreover, Ikoma et al evaluated the clinical impact of change in CAR in 97 gastric cancer patients who received immune checkpoint inhibitor therapy [17]. They found that patients with low change in CAR (≤ 0.01) during immune checkpoint inhibitor therapy had better survival than those with high change in CAR (> 0.01).…”

Section: Discussionmentioning

confidence: 99%

The Clinical Impact of Change in the C-Reactive Protein/Albumin Ratio in Gastric Cancer Patients Who Receive Curative Treatment

Aoyama,

Maezawa,

Hashimoto

et al. 2023

J Gastrointest Canc

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Background Recently, change in the C-reactive protein/albumin ratio (CAR) has become a promising prognostic marker in some malignancies. The aim of the present study was to evaluate the clinical impact of change in the CAR in gastric cancer patients who received curative resection. Method The present study included 458 patients who underwent curative treatment for gastric cancer between 2013 and 2017. The prognosis and clinicopathological parameters were compared between patients who showed a high-change in CAR and those who showed a low-change in CAR. Results The OS stratified by each clinical factor was compared using a log-rank test, and a significant difference was observed using a 0.05 change in CAR. When the patient background factors were compared between the high-change (change in CAR ≥ 0.05) and low-change (change in CAR < 0.05) groups, the median age, sex ratio, T factor, and N factor were similar. In the low-change group, the OS rates at 3 and 5 years after surgery were 94.1% and 87.6%, respectively, which amounted to a significant difference from the low-change group, with rates of 83.6 and 77.5% in the high-change group. In the low-change group, the RFS rates at 3 and 5 years after surgery were 90.1% and 85.1%, respectively, while those in the high-change group 77.6 and 75.2%. The univariate and multivariate analyses of factors associated with OS and RFS showed that the change in CAR was a significant prognostic factor. Conclusions The change in CAR is a significant risk factor and promising prognostic factor for gastric cancer patients.

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Improvement of Body Weight and Nutritional Status in Gastric Cancer Patients Enhances the Benefit of Nivolumab Therapy

Cited by 3 publications

References 18 publications

Exploring the optimal indicator of short‐term peridiagnosis weight dynamics to predict cancer survival: A multicentre cohort study

Exploring the optimal indicator of short‐term peridiagnosis weight dynamics to predict cancer survival: A multicentre cohort study

Clinical Effect of the C-Reactive Protein to Serum Albumin Ratio in Patients with Metastatic Gastric or Gastroesophageal Junction Cancer Treated with Trifluridine/Tipiracil

The Clinical Impact of Change in the C-Reactive Protein/Albumin Ratio in Gastric Cancer Patients Who Receive Curative Treatment

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