TY - JOUR
T1 - Body mass index and survival after surgery for gastric adenocarcinoma
T2 - a population-based nationwide cohort study in Finland
AU - Jalkanen, Aapo
AU - Kokkola, Arto
AU - Louhimo, Johanna
AU - Helminen, Olli
AU - Helmiö, Mika
AU - Huhta, Heikki
AU - Junttila, Anna
AU - Kallio, Raija
AU - Koivukangas, Vesa
AU - Laine, Simo
AU - Lietzen, Elina
AU - Meriläinen, Sanna
AU - Pohjanen, Vesa Matti
AU - Rantanen, Tuomo
AU - Ristimäki, Ari
AU - Räsänen, Jari V.
AU - Saarnio, Juha
AU - Sihvo, Eero
AU - Toikkanen, Vesa
AU - Tyrväinen, Tuula
AU - Valtola, Antti
AU - Puolakkainen, Pauli
AU - Kauppila, Joonas H.
N1 - Publisher Copyright:
© 2025 Society for Surgery of the Alimentary Tract.
PY - 2026/1
Y1 - 2026/1
N2 - Background Gastric cancer surgery is associated with significant morbidity. Obesity is a risk factor for short-term complications. However, previous studies on the role of body mass index (BMI) as a predictor of long-term survival have conflicting results, and contemporary population-based data in the Western population are lacking. This study aimed to compare the long-term survival after gastric cancer surgery among patients who were underweight (BMI of <18.5 kg/m2), those with normal weight (BMI of 18.5–24.9 kg/m2), those who were overweight (BMI of 25.0–29.9 kg/m2), and those who were obese (BMI of >30.0 kg/m2). Methods This was a population-based, retrospective, nationwide cohort study in Finland using the Finnish National Esophago-Gastric Cancer Cohort. Patients who underwent gastrectomy with available height and weight data were included. A Cox regression model was used to calculate the 95% CI for 6-month to 5-year survival and 6-month survival, which was adjusted for age, sex (assigned), year of surgery, Charlson Comorbidity Index, pathological p/yp stage, neoadjuvant therapy, type of resection, and Lauren histological type. Results Overall, 1647 patients who underwent gastrectomy for gastric cancer were identified. Of the patients, 64 (3.9%) were underweight, 735 (44.6%) had normal weight, 584 (35.5%) were overweight, and 264 (16.0%) were obese. In the first 6 months, mortality was higher in the overweight group (hazard ratio [HR], 1.663 [95% CI, 1.158–2.389]) than in the normal weight group. However, 6-month to 5-year mortality was the highest in the underweight group (HR, 1.426 [95% CI, 1.019–1.994]) and decreased with increasing BMI (HR, 0.820 [95% CI, 0.708–0.949]). Patients with obesity had the best prognosis (HR, 0.798 [95% CI, 0.655–0.971]). Conclusion In this population-based study, higher BMI was associated with better long-term survival after gastric cancer surgery, somewhat offset by higher mortality during the first postoperative months, with patients with obesity having the best overall survival.
AB - Background Gastric cancer surgery is associated with significant morbidity. Obesity is a risk factor for short-term complications. However, previous studies on the role of body mass index (BMI) as a predictor of long-term survival have conflicting results, and contemporary population-based data in the Western population are lacking. This study aimed to compare the long-term survival after gastric cancer surgery among patients who were underweight (BMI of <18.5 kg/m2), those with normal weight (BMI of 18.5–24.9 kg/m2), those who were overweight (BMI of 25.0–29.9 kg/m2), and those who were obese (BMI of >30.0 kg/m2). Methods This was a population-based, retrospective, nationwide cohort study in Finland using the Finnish National Esophago-Gastric Cancer Cohort. Patients who underwent gastrectomy with available height and weight data were included. A Cox regression model was used to calculate the 95% CI for 6-month to 5-year survival and 6-month survival, which was adjusted for age, sex (assigned), year of surgery, Charlson Comorbidity Index, pathological p/yp stage, neoadjuvant therapy, type of resection, and Lauren histological type. Results Overall, 1647 patients who underwent gastrectomy for gastric cancer were identified. Of the patients, 64 (3.9%) were underweight, 735 (44.6%) had normal weight, 584 (35.5%) were overweight, and 264 (16.0%) were obese. In the first 6 months, mortality was higher in the overweight group (hazard ratio [HR], 1.663 [95% CI, 1.158–2.389]) than in the normal weight group. However, 6-month to 5-year mortality was the highest in the underweight group (HR, 1.426 [95% CI, 1.019–1.994]) and decreased with increasing BMI (HR, 0.820 [95% CI, 0.708–0.949]). Patients with obesity had the best prognosis (HR, 0.798 [95% CI, 0.655–0.971]). Conclusion In this population-based study, higher BMI was associated with better long-term survival after gastric cancer surgery, somewhat offset by higher mortality during the first postoperative months, with patients with obesity having the best overall survival.
KW - Body mass index
KW - Gastric cancer
KW - Surgery
KW - Survival
UR - https://www.scopus.com/pages/publications/105022498857
U2 - 10.1016/j.gassur.2025.102282
DO - 10.1016/j.gassur.2025.102282
M3 - Article
AN - SCOPUS:105022498857
SN - 1091-255X
VL - 30
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 1
M1 - 102282
ER -
