Survival benefit of nutritional support in advanced gastric cancer patients receiving chemotherapy: A propensity score–matched study.

Abstract

354 Background: Malnutrition is highly prevalent among patients with advanced gastric cancer (AGC) and is known to impair tolerance to systemic therapy, potentially leading to inferior outcomes. Nutritional support team (NST) interventions are frequently introduced in clinical practice; however, their prognostic relevance in AGC remains insufficiently defined. Methods: We retrospectively reviewed consecutive AGC patients treated with first-line chemotherapy at our institution between 2007 and 2024. Patients receiving NST were compared with those managed with routine care (RC). To minimise baseline imbalances, clinical variables, including nutritional and inflammatory markers, were adjusted using 1:1 propensity score matching (PSM). The primary endpoint was time to treatment failure (TTF), with overall survival (OS) as a secondary endpoint. Prespecified subgroup analyses were conducted according to serum albumin levels (<3.5 vs ≥3.5 g/dL). Results: Among 324 eligible patients, 76 (23%) underwent NST. Compared with RC, NST was more frequently introduced in patients with poor nutritional and inflammatory profiles. Median f/u time was 54.2 (95%CI: 50.9–57.4) months. After PSM (46 pairs), median OS was 16.6 vs 12.0 months (hazard ratio [HR] 0.83, p=0.411) and median TTF was 5.0 vs 4.6 months (HR 0.91, p=0.647), showing no significant differences. In the hypoalbuminemia subgroup, however, NST was associated with significantly prolonged TTF (5.0 vs 3.7 months; HR 0.67, p=0.025). On multivariate analysis of the entire pre-PSM cohort, NST independently predicted longer TTF (HR 0.58; 95% CI 0.43–0.78, p<0.001). Conclusions: NST did not demonstrate a survival advantage in the overall AGC population; however, it contributed to the maintenance of chemotherapy in patients with hypoalbuminemia. These findings suggest that targeted nutritional intervention for high-risk patients may represent a pragmatic strategy to preserve treatment delivery and potentially improve outcomes.