Elevated prealbumin levels after preoperative nutritional intervention is an independent prognostic factor for overall survival after radical gastrectomy in patients with gastric cancer and severe malnutrition.

Purpose: This study aimed to clarify the effects of preoperative nutritional intervention on long-term survival after radical gastrectomy in patients with severe malnutrition.

Methods: This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary stages I-III gastric cancer between August 2010 and December 2021. The primary outcome measure was overall survival (OS). We compared OS between the groups with and without nutritional intervention. In the intervention group, we compared OS between the groups with and without nutritional improvement. Prognostic factors were identified using the Cox proportional hazards regression analysis.

Results: Median follow-up duration was 51 months. Of the 118 patients, 35 (29.7%) and 83 (70.3%) were in the group without and with nutritional intervention, respectively. Of the 83 patients in the group with nutritional intervention, 24 (28.9%) were classified as group without elevated prealbumin levels and 59 (71.1%) as group with elevated prealbumin levels. There was no difference in OS between the groups with and without nutritional intervention (P = 0.532); however, there was a trend toward better OS in the group with elevated prealbumin levels than in the group without elevated prealbumin levels (P = 0.181). Multivariate analysis showed that elevated prealbumin levels after intervention was an independent, favorable, prognostic factor for OS (hazard ratio, 0.320; 95% confidence interval, 0.112-0.917; P = 0.030).

Conclusions: Preoperative nutritional therapy in patients with severe malnutrition does not contribute to long-term survival after gastrectomy. However, in patients who have undergone nutritional therapy, prognosis could be predicted by elevated prealbumin levels.