Preoperative Cachexia Index Predicts Overall Survival Following Curative Resection for Remnant Gastric Cancer

Background/Aim: Remnant gastric cancer (RGC) remains a clinically challenging condition, and prognostic biomarkers reflecting host-related vulnerability are needed. The cachexia index (CXI), incorporating skeletal muscle mass, serum albumin, and the neutrophil-to-lymphocyte ratio, has been reported as a prognostic indicator in several malignancies. However, its clinical significance in RGC remains unclear. This study aimed to evaluate the prognostic value of preoperative CXI in patients undergoing curative resection for RGC.

Patients and Methods: We retrospectively analyzed 51 patients who underwent curative resection for RGC between January 2004 and December 2020. Sex-specific CXI cutoff values were determined using receiver operating characteristic curve analysis based on 5-year overall survival (OS). OS and disease-specific survival (DSS) were assessed using the Kaplan-Meier method and Cox proportional hazards models.

Results: Seventeen patients were classified into the high-CXI group and 34 into the low-CXI group. Multivariable Cox regression analysis demonstrated that low CXI was independently associated with poorer OS after adjustment for pathological tumor depth (hazard ratio=5.284, 95% confidence interval=1.222-22.856, p=0.026). CXI was not significantly associated with DSS. Non-cancer-related deaths occurred more frequently in the low-CXI group.

Conclusion: Low preoperative CXI is an independent predictor of poor OS in patients with RGC and may reflect host-related vulnerability rather than tumor aggressiveness. CXI could serve as a useful biomarker for perioperative risk stratification in RGC.