Gastric Cancer

, Volume 21, Issue 6, pp 913–924 | Cite as

Body mass index and mortality in patients with gastric cancer: a large cohort study

  • Jung Hwan Lee
  • Boram Park
  • Jungnam JooEmail author
  • Myeong-Cherl Kook
  • Young-Il Kim
  • Jong Yeul Lee
  • Chan Gyoo Kim
  • Il Ju Choi
  • Bang Wool Eom
  • Hong Man Yoon
  • Keun Won Ryu
  • Young-Woo Kim
  • Soo-Jeong ChoEmail author
Original Article



The effects of obesity on prognosis in gastric cancer are controversial.


To evaluate the association between body mass index (BMI) and mortality in patients with gastric cancer.


A single-institution cohort of 7765 patients with gastric cancer undergoing curative gastrectomy between October 2000 and June 2016 was categorized into six groups based on BMI: underweight (< 18.5 kg/m2), normal (18.5 to < 23 kg/m2), overweight (23 to < 25 kg/m2), mildly obese (25 to < 28 kg/m2), moderately obese (28 to < 30 kg/m2), and severely obese (≥ 30 kg/m2). Hazard ratios (HRs) for overall survival (OS) and disease-specific survival (DSS) were calculated using Cox proportional hazard models.


We identified 1279 (16.5%) all-cause and 763 (9.8%) disease-specific deaths among 7765 patients over 83.05 months (range 1.02–186.97) median follow-up. In multivariable analyses adjusted for statistically significant clinicopathological characteristics, preoperative BMI was associated with OS in a non-linear pattern. Compared with normal-weight patients, underweight patients had worse OS [HR 1.42; 95% confidence interval (CI) 1.15–1.77], whereas overweight (HR 0.84; 95% CI 0.73–0.97), mildly obese (HR 0.77; 95% CI 0.66–0.90), and moderately obese (HR 0.77; 95% CI 0.59–1.01) patients had better OS. DSS exhibited a similar pattern, with lowest mortality in moderately obese patients (HR 0.58; 95% CI 0.39–0.85). Spline analysis showed the lowest all-cause mortality risk at a BMI of 26.67 kg/m2.


In patients undergoing curative gastric cancer surgery, those who were overweight or mildly-to-moderately obese (BMI 23 to < 30 kg/m2) preoperatively had better OS and DSS than normal-weight patients.


Body mass index Gastric cancer Mortality Obesity Gastrectomy 



This study was supported by Grants from the National Cancer Center, Korea (#1610160-2) and the National Research Foundation (#NRF-2016R1A2B1010377).

Author contributions

JHL contributed to data acquisition, analysis and interpretation of data, and drafting of the manuscript; BP contributed to statistical analysis, interpretation of data, and drafting of the manuscript; JJ contributed to statistical analysis, interpretation of data and administrative support; M-CK contributed to pathological analysis and interpretation of data; Y-IK contributed to critical revision of the manuscript for important intellectual content; JYL contributed to critical revision of the manuscript for important intellectual content; CGK contributed to critical revision of the manuscript for important intellectual content; IJC contributed to critical revision of the manuscript for important intellectual content; BWE contributed to critical revision of the manuscript for important intellectual content; HMY contributed to critical revision of the manuscript for important intellectual content; KWR contributed to critical revision of the manuscript for important intellectual content; Y-WK contributed to critical revision of the manuscript for important intellectual content; S-JC contributed to study concept and design, analysis and interpretation of data, drafting of the manuscript, obtained funding, and study supervision.

Compliance of ethical standards

Conflicts of interest

The authors declare that there are no conflicts of interest.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or a substitute for it was obtained from all patients for being included in the study.

Supplementary material

10120_2018_818_MOESM1_ESM.docx (60 kb)
Supplementary material 1 (DOCX 59 kb)
10120_2018_818_MOESM2_ESM.tif (88 kb)
Supplementary material 2 (TIFF 87 kb) Supple Fig. 1. Kaplan–Meier curves according to body mass index at diagnosis for each TNM stage group (A) overall survival and (B) disease-specific survival
10120_2018_818_MOESM3_ESM.tif (91 kb)
Supplementary material 3 (TIFF 90 kb)


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  1. 1.Center for Gastric Cancer, National Cancer CenterIlsandong-gu GoyangRepublic of Korea
  2. 2.Biometrics Research Branch, Research InstituteNational Cancer CenterIlsandong-gu GoyangRepublic of Korea

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