Prognostic value of preoperative body mass index for diabetic patients with non-metastasis gastric cancer: a single center experience

AIM: This study was designed to investigate the prognostic effect of preoperative body mass index (BMI) for Type 2 diabetes mellitus (T2DM) patients with non-metastasis gastric cancer (GC) who underwent D(2) gastrectomy. METHODS: T2DM patients with pT(1–4b)N(0–3b)M(0) GC were retrospectively collected in Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital from January, 2000 to December, 2010. These patients underwent D(2) radical resection of the stomach combined with regional lymphadenectomy. Chi-square test was used to analyze unordered categorical variables and ranked data, followed by Kaplan–Meier analysis as well as Cox regression models to detect risk factors for survival outcomes. In addition, the cut-off point was determined by the X-tile program. All analyses were carried out using survival package of R and SPSS Software. RESULTS: A total of 302 T2DM patients with pT(1–4b)N(0–3b)M(0) GC were collected and analyzed. The cut-off points of BMI, identified by the X-tile program, was 19 kg/m(2). Patients with low BMI (< 19 kg/m(2)) had a higher percentage of advanced T stage (T(4a) and T(4b)), more advanced TNM stage (stage IIIA, IIIB and IIIC), and more elevated level of serum carcinoembryonic antigen (CEA), compared to those with high BMI (> 19 kg/m(2)) (all P < 0.05). In the low BMI subgroup, the 5-year overall survival rate was 39.02%, which was as high as 58.11% in the high BMI subgroup (P < 0.05). In the multivariate Cox regression model revealed that III(C) stage (OR = 3.101), N(3b) stage (OR = 3.113) were the most important prognostic indicators, followed by pretreatment BMI (OR = 2.136). CONCLUSION: Low preoperative BMI (< 19 kg/m(2)) was a poor prognostic marker for T2DM patients with pT(1–4b)N(0–3b)M(0) GC.