Studio osservazionale monocentrico sui cambiamenti di composizione corporea nei pazienti con cancro gastrico resecabile chemiotrattati con il regime perioperatorio FLOT.

Gastric cancer is one of the malignancy with the worst prognosis worldwide. Nevertheless, in recent years, improved diagnostic and therapeutic approaches have significantly mitigated the prognosis of these patients. In approximately 20% of cases, gastric cancer occurs as resectable, meaning it is limited or locally advanced. In the first case, surgery is performed upfront and then followed by adjuvant chemotherapy, while in the second case, the standard of care is a complex care program which includes perioperative chemotherapy (before and after surgery) and surgery. Since 2019, the reference chemotherapy regimen for perioperative treatment has been the FLOT scheme. Malnutrition is a parameter which negatively affects the prognosis of patients with gastric cancer, at all disease stages. It is estimated that 75% of patients with gastric cancer are malnourished at diagnosis. For this reason, oncology research has focused on this topic in recent years. Our work fits precisely within this research framework and aimed to analyze the changes in body composition of patients with resectable gastric cancer and chemotreated with the FLOT regimen. Specifically, we analyzed 87 patients attending the oncology department of the “Policlinico San Matteo” Hospital in Pavia (Italy), from January 2012 to August 2025. We subsequently focused on the group of patients who received the FLOT regimen as a perioperative regimen, and the patient cohort was divided into two study groups: patients who received early nutritional support (46.7%) and patients who did not (53.3%). The study's primary endpoint was the dynamic assessment of changes in body composition in relation to early nutritional support. Three body composition parameters (skeletal muscle mass index, visceral adipose tissue index and subcutaneous adipose tissue index) were analyzed at three key timepoints in the oncology pathway (diagnosis, pre-surgery and post-surgery). The results showed that, although in both study groups there was a progressive decline in parameters, the group of patients who received early nutritional support had a milder decline than the comparison group. Secondary endpoints were DFS and OS. DFS was 67,7 months versus 47,5 (p value 0,038), respectively between patients without early nutritional support and patient with early nutritional support. OS was 69,3 months versus 68,1 (p value 0,603), between the two respective comparison arms (no early nutritional support and patients with early nutritional support). While the DFS curves faithfully reflect the reported means, the OS curves, after an initial advantage for patients who did not receive nutritional support, invert, showing a clear benefit for the group of patients who received nutritional support. Our work present four important methodological limitations: the sample size, the complexity of performing an analysis across a complex treatment pathway, the difficulty in processing data regarding patients' nutritional status and finally the lack of universal nutritional screening. It is natural to understand that the group of patients who received early nutritional support consisted of malnourished patients who therefore started disadvantaged already at diagnosis. Despite the stated limitations, our study allows us to draw some important conclusions: nutrition plays a central role in oncology, demonstrating to be a factor modulating treatment adherence and patients prognosis. Early nutritional support, while not completely avoiding it, slows muscle loss. Finally, it seems to have a modest, though not statistically significant, impact on survival.