ObjectiveTo longitudinally investigate the characteristics of postoperative weight changes in patients with esophageal cancer and analyze its influencing factors, which can provide certain guidance for nutritional intervention in patients with esophageal cancer. MethodsPatients with esophageal cancer who underwent surgical treatment at the Sichuan Cancer Hospital from December 2020 to February 2022 were prospectively included. The general information questionnaire and body composition analyzer were used to longitudinally investigate the patients’ weight and body composition before surgery (T0), 1 month after surgery (T1), 3 months after surgery (T2) and 6 months after surgery (T3), and the change characteristics were analyzed. The generalized estimating equation was used to analyze the influencing factors for postoperative weight changes in patients with esophageal cancer. ResultsA total of 130 patients were enrolled, including 110 males and 20 females, aged 42-79 (63.33±8.16) years. The weight and body composition of patients with esophageal cancer showed a continuous slow downward trend within 6 months after surgery. The weight loss rate of patients at 1, 3, and 6 months after surgery was 5.10%, 7.76%, and 9.86%, respectively. The analysis results of the influencing factors for postoperative weight showed that patients with the following characteristics had more weight loss: female (β=?7.703, P=0.001), ≥60 years (β=?3.657, P=0.010), smoking (β=4.622, P=0.010), low tumor differentiation degree (β=4.314, P=0.039), and high frequency of eating (β=?3.400, P=0.008). ConclusionWeight loss is an important health problem for patients with esophageal cancer after surgery, and patients have a continuous downward trend in weight within 6 months after surgery. Medical staff should pay special attention to the patients who are female, ≥60 years, having smoking history and low tumor differentiation degree.
ObjectiveTo observe the changes of body composition in patients with obesity after sleeve gastrectomy (SG) and know the factors affecting the effective weight loss. MethodsThe obese patients who received SG treatment at the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University from October 2019 to October 2022 were included according to the inclusion and exclusion criteria. The anthropometric parameters, lipid metabolism indexes, and body composition data were collected before surgery (1 d) and at 1-, 3-, 6-, and 12-month after surgery. The risk factors affecting the effective weight loss were analyzed. ResultsA total of 170 patients were included in the study. ① The anthropometric parameters such as body weight, body mass index, waist circumference, hip circumference, and waist-to-hip ratio at different time points after surgery as compared with the baseline (1 day before surgery) values were decreased (P<0.05) and showed continuous downward trends after surgery (P<0.05), meanwhile the percentage total weight loss and percentage excess weight loss (%EWL) indicators showed continuous upward trends (P<0.05). ② The lipid metabolic indexes such as triglyceride, total cholesterol, and uric acid, except for the total cholesterol indexes at the 6th and 12th month had no statistical differences as compared with the baseline value (P>0.05) and the uric acid was increased at the 1st month after surgery (P<0.05), the other indexes at different time points after surgery showed continuous downward trends as compared with the baseline values (P<0.05). ③ All the body composition parameters except percentage fat-free mass of the left and right lower limbs (P>0.05) at different time points after surgery as compared with the baseline values were decreased (P<0.05), and some body composition indicators, such as fat mass, percentage fat mass, visceral fat area, and obesity degree continued to decrease within 1 year after surgery (P<0.05). ④ There were 93 patients with reaching the standard of effective weight loss (%EWL was 50% or more). The multivariate logistic regression analysis showed that the lower fat mass of right lower limb, the higher probability of effective weight loss [OR (95%CI)=0.452 (0.290, 0.703), P<0.001]. The area under the receiver operating characteristic curve of the fat mass of the right lower limb was 0.782 [95%CI=(0.672, 0.893), P<0.001], its sensitivity and specificity were 0.679 and 0.792, respectively, and the cut-off value was 7.35 kg. ConclusionsThe results of this study suggest that SG can markedly improve the anthropometric and lipid metabolism indicators of patients with obesity, and achieve effective weight loss in a short-time. The body composition from the whole body to limbs and trunk might be changed. The fat mass of the right lower limb is closely related to the short-term effective weight loss after surgery and it has a moderate ability to distinguish achieving effective weight loss.
ObjectiveTo evaluate the predictive performance of a nomogram model integrating preoperative CT body composition parameters, clinical laboratory indicators, and postoperative pathological TNM (pTNM) staging for overall survival in patients with gastric cancer after radical gastrectomy. MethodsClinical data were retrospectively collected from patients who underwent radical gastrectomy for gastric cancer at the First Affiliated Hospital of Chengdu Medical College from January 2017 to January 2025, including general information, abdominal CT-derived body composition parameters within 1 week before surgery, blood routine test results, tumor markers, and postoperative pTNM staging data. Univariate and multivariate Cox proportional-hazards regression were used to analyze the relation between each indicator and overall survival (variables with P<0.10 in univariate analysis were included in the multivariate analysis). A nomogram was constructed to predict the 1-, 2-, and 3-year overall survival probabilities. The C-index and time-dependent area under the curve (AUC) were used to evaluate model discrimination. Calibration curves were plotted to assess calibration performance, and decision-curve analysis (DCA) was performed to evaluate clinical net benefit. Based on the total risk score derived from the nomogram, the optimal cut-off value was determined using X-tile software, and patients were divided into high- and low-risk groups. Kaplan-Meier survival curves were plotted to compare overall survival differences between the two groups. ResultsA total of 191 eligible gastric cancer patients were enrolled in this study. Multivariate Cox proportional-hazards regression analysis demonstrated that carcinoembryonic antigen (CEA) >5 μg/L (HR=2.696, P=0.001), lymphocyte count <1.1×109/L (HR=2.027, P=0.013), pTNM stage Ⅲ–Ⅳ (HR=3.607, P<0.001), and increase in standardized subcutaneous fat density (HR=1.685, P<0.001) were independent risk factors for shortened overall survival. Collinearity was diagnosed, and variance inflation factors of <10 were observed for all four variables. An AUC of 0.762 [95%CI (0.686, 0.838)] for discriminating overall survival was achieved by the combination of these four indicators. Based on the nomogram risk score constructed from the four indicators, the optimal cutoff value of 5.723 was determined using X-tile software, and patients were divided into a high-risk group (n=59) and a low-risk group (n=132). The overall survival of patients in the high-risk group was poorer than that in the low-risk group (χ2=67.58, P<0.001). A C-index of 0.758 [95%CI (0.689, 0.823)] was calculated for the nomogram model, and after internal validation using the Bootstrap method (1 000 resamples), a C-index of 0.749 [95%CI (0.675, 0.825)] was obtained. The AUCs (95%CIs) for predicting 1-, 2-, and 3-year overall survival probabilities were calculated as 0.788 (0.679, 0.891), 0.811 (0.733, 0.893), and 0.856 (0.790, 0.919), respectively. Calibration curves showed that the predicted 1-, 2-, and 3-year survival probabilities generally approximated the ideal curves. DCA demonstrated that, within a threshold probability range of 5%–50%, clinical net benefit was provided for patients by the nomogram model. ConclusionsThe results of this study indicate that increased standardized subcutaneous fat density quantified by preoperative CT, elevated preoperative CEA levels, decreased preoperative lymphocyte count, and advanced postoperative pTNM stage are independent risk factors for poor overall survival in patients after radical gastrectomy for gastric cancer. The nomogram model constructed based on these factors exhibits good discriminative ability in predicting 1-, 2-, and 3-year overall survival probabilities, and DCA confirms that it offers a positive net benefit in clinical decision-making.