J Gastric Cancer.  2018 Sep;18(3):274-286. 10.5230/jgc.2018.18.e30.

The Impact of Preoperative Low Body Mass Index on Postoperative Complications and Long-term Survival Outcomes in Gastric Cancer Patients

  • 1Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea. kjj@catholic.ac.kr


The aim of this study was to investigate the impact of preoperative low body mass index (BMI) on both the short- and long-term outcomes in patients with gastric cancer.
A total of 510 patients with gastric cancer were divided into the following 3 groups: low BMI group (≤18.5 kg/m2, n=51), normal BMI group (18.6-24.9 kg/m2, n=308), and high BMI group (≥25.0 kg/m2, n=151).
There were significantly more stage III/IV patients in the low BMI group than in the other groups (P=0.001). Severe postoperative complications were more frequent (P=0.010) and the survival was worse (P < 0.001) in the low BMI group. The subgroup analysis indicated that survival was worse in the low BMI group of the stage I/II subgroup (P=0.008). The severe postoperative complication rate was higher in the low BMI group of the stage III/IV subgroup (P=0.001), although the recurrence rate and survival did not differ in the stage III/IV subgroup among all the BMI groups. Low BMI was an independent poor prognostic factor in the stage I/II subgroup (disease-free survival: hazard ratio [HR], 13.521; 95% confidence interval [CI], 1.186-154.197; P=0.036 and overall survival: HR, 5.130; 95% CI, 1.644-16.010; P=0.005), whereas low BMI was an independent risk factor for severe postoperative complications in the stage III/IV subgroup (HR, 17.158; 95% CI, 1.383-212.940; P=0.027).
Preoperative low BMI in patients with gastric cancer adversely affects survival among those with stage I/II disease and increases the severe postoperative complication rate among those with stage III/IV disease.


Stomach neoplasms; Body mass index; Obesity; Underweight

MeSH Terms

Body Mass Index*
Postoperative Complications*
Risk Factors
Stomach Neoplasms*


  • Fig. 1 Kaplan-Meier DFS curves for gastric cancer patients, stratified by the BMI groups. (A) DFS in all patients, (B) DFS in stage I and II patients, and (C) DFS in stage III patients. DFS = disease-free survival; BMI = body mass index.

  • Fig. 2 Kaplan-Meier OS curves for gastric cancer patients, stratified by the BMI groups. (A) OS in all patients, (B) OS in stage I and II patients, and (C) OS in stage III and IV patients. OS = overall survival; BMI = body mass index.

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