Abstract
BACKGROUND: Malnutrition is highly prevalent in gastric cancer patients receiving adjuvant chemotherapy and may compromise treatment completion and survival outcomes. The comparative predictive value of various nutritional assessment tools in this clinical setting remains unclear. AIM: To investigate the impact of nutritional status on treatment completion and prognosis during adjuvant chemotherapy following gastric cancer surgery, providing scientific evidence for clinical nutritional intervention strategies. METHODS: A retrospective analysis was conducted on clinical data of 80 patients who received adjuvant chemotherapy after gastric cancer surgery from January 2020 to June 2024. Nutritional status was assessed using Nutritional Risk Screening 2002 (NRS2002), Controlling Nutritional Status, Prognostic Nutritional Index (PNI), and Glasgow Prognostic Score before and after chemotherapy. Patients were divided into nutritional risk group (NRS2002 ≥ 3 points, n = 37) and non-nutritional risk group (< 3 points, n = 43) based on NRS2002 scores. Treatment completion, adverse reactions, and survival prognosis were evaluated. Logistic regression analysis was used to identify risk factors affecting treatment completion, and Cox regression analysis was used to analyze prognostic factors. RESULTS: Thirty-seven patients (46.2%) had nutritional risk before chemotherapy. The nutritional risk group had significantly lower treatment completion rate compared to the non-nutritional risk group (75.7% vs 95.3%, P = 0.009), insufficient relative dose intensity (78.6% ± 14.2% vs 92.1% ± 8.7%, P < 0.001), and significantly higher incidence rates of ≥ grade 3 hematologic and non-hematologic toxicities (P < 0.05). With a median follow-up of 28 months, the nutritional risk group had significantly lower 3-year disease-free survival (DFS) and overall survival (OS) rates compared to the non-nutritional risk group (62.1% vs 83.7%, P = 0.018; 72.4% vs 90.7%, P = 0.023). Multivariate analysis showed that NRS2002 ≥ 3 points was an independent risk factor for treatment completion [odds ratio = 4.829, 95% confidence interval (CI): 1.542-15.114, P = 0.007], DFS [hazard ratio (HR) = 2.847, 95%CI: 1.124-7.214, P = 0.027], and OS (HR = 3.524, 95%CI: 1.089-11.404, P = 0.036). CONCLUSION: Nutritional status significantly affects treatment completion and prognosis in gastric cancer patients receiving postoperative adjuvant chemotherapy. Both NRS2002 and PNI demonstrate important predictive value, with NRS2002 showing the most consistent performance in predicting treatment completion and survival outcomes. Clinical practice should emphasize nutritional risk assessment and dynamic monitoring, and develop individualized nutritional intervention strategies to improve chemotherapy completion rates and patient outcomes.