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Meta-Analysis
. 2025 Jan 28;20(1):e0317985.
doi: 10.1371/journal.pone.0317985. eCollection 2025.

Association of preoperative body mass index with postoperative complications and survival for patients with gastric cancer: A systematic review and meta-analysis

Zhenzhen Li  1 , Lili Cui  1 , Jing Sun  1 , Wanlu Liu  1
Affiliations
Meta-Analysis

Association of preoperative body mass index with postoperative complications and survival for patients with gastric cancer: A systematic review and meta-analysis

Zhenzhen Li et al. PLoS One. .

Abstract

Objective: The relationship among body mass index (BMI), postoperative complications, and clinical outcomes in patients undergoing gastrectomy for gastric cancer remains unclear. This study aimed to evaluate this association using a meta-analysis.

Method: We conducted a systematic search of the PubMed, Embase, and Cochrane Library databases up to February 25, 2024. Patients were classified into underweight (<18.5 kg/m2), normal weight (18.5-25.0 kg/m2), and overweight (≥25.0 kg/m2) groups based on BMI categories. Meta-analysis was performed using a random-effects model. Additionally, exploratory sensitivity and subgroup analyses were performed.

Results: Twenty-two studies involving 41,144 patients with gastric cancer were included for quantitative analysis. Preoperative underweight (odds ratio [OR]: 1.26; 95% confidence interval [CI]: 1.03-1.55; P = 0.024) and overweight (OR: 1.19; 95%CI: 1.09-1.30; P <0.001) were associated with an increased risk of postoperative complications. Furthermore, preoperative underweight was associated with poorer overall survival (hazard ratio [HR]: 1.40; 95%CI: 1.28-1.53; P <0.001), whereas preoperative overweight was associated with better over-survival (HR: 0.82; 95%CI: 0.73-0.91; P <0.001). Furthermore, preoperative underweight was not associated with disease-free survival (HR: 1.48; 95%CI: 0.97-2.26; P = 0.069), whereas preoperative overweight was associated with longer disease-free survival (HR: 0.80; 95%CI: 0.70-0.91; P = 0.001). In terms of specific postoperative complications, preoperative underweight was associated with an increased risk of septic shock (OR: 3.40; 95%CI: 1.26-9.17; P = 0.015) and a reduced risk of fever (OR: 0.39; 95%CI: 0.18-0.83; P = 0.014). Preoperative overweight was associated with an increased risk of wound infections (OR: 1.78; 95%CI: 1.08-2.93; P = 0.023), intestinal fistula (OR: 5.23; 95%CI: 1.93-14.21; P = 0.001), arrhythmia (OR: 6.38; 95%CI: 1.70-24.01; P = 0.006), and pancreatic fistula (OR: 3.37; 95%CI: 1.14-9.96; P = 0.028).

Conclusion: This study revealed that both preoperative underweight and overweight status were associated with an increased risk of postoperative complications. Moreover, the postoperative survival outcomes were significantly better in overweight compared to that of underweight patients.

Trial registration: Registration: INPLASY202480004.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Literature search and study selection details.
Fig 2
Fig 2. Association of preoperative BMI with the risk of postoperative complications.
Fig 3
Fig 3. Association of preoperative BMI with OS.
Fig 4
Fig 4. Association of preoperative BMI with DFS.
See this image and copyright information in PMC

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References

    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al.. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–249. doi: 10.3322/caac.21660 - DOI - PubMed
    1. Arnold M, Ferlay J, van Berge Henegouwen MI, Soerjomataram I. Global burden of oesophageal and gastric cancer by histology and subsite in 2018. Gut. 2020;69(9): 1564–1571. doi: 10.1136/gutjnl-2020-321600 - DOI - PubMed
    1. Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet. 2020;396(10251): 635–648. doi: 10.1016/S0140-6736(20)31288-5 - DOI - PubMed
    1. Thrift AP, El-Serag HB. Burden of Gastric Cancer. Clin Gastroenterol Hepatol. 2020;18(3):534–542. doi: 10.1016/j.cgh.2019.07.045 - DOI - PMC - PubMed
    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. doi: 10.3322/caac.21492 - DOI - PubMed

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