Association between weight loss and survival outcomes in patients with gastric cancer: a meta-analysis

Patients with gastric cancer often experience weight loss. A meta-analysis was conducted to evaluate the association between weight loss and survival outcomes in gastric cancer patients. We searched PubMed, Embase, and Web of Science according to the PECOS criteria: population (gastric cancer patients), exposure (weight loss), comparator (weight stable), outcomes [overall survival (OS) or recurrence-free survival], and study design (cohort studies). The prognostic value was expressed by combing the fully adjusted hazard ratio with 95% confidence interval (CI) for weight loss versus stable weight. Eighteen studies reporting on 16 articles involving 26 080 patients were identified. The pooled adjusted relative risk showed that weight loss was associated with shorter OS (hazard ratio 1.48; 95% CI: 1.32-1.66; I2 = 71.0%) and recurrence-free survival (hazard ratio 1.59; 95% CI: 1.17-2.16; I2 = 52.0%). The pooled adjusted hazard ratio of OS was 1.39 (95% CI: 1.14-1.70; I2 = 74.6%) among the studies that defined weight loss meeting the criteria for cancer cachexia. Moreover, stratified analysis revealed that weight loss significantly predicted OS, irrespective of patients' age, study design, tumor stage, timing of sampling weight loss, or follow-up duration. Weight loss significantly predicts OS and recurrence-free survival in gastric cancer patients. Monitoring weight changes can improve risk classification of gastric cancer, particularly in those with advanced disease.