Impact of nutritional risk screening on outcomes of first-line treatment in metastatic esophagogastric adenocarcinoma: a secondary analysis of the AIO-MATEO trial

Background: Malnutrition is common in patients with metastatic esophagogastric adenocarcinoma (EGA). However, the prognostic impact of nutritional risk screening (NRS) in advanced EGA remains underexplored. This preplanned analysis of the phase II AIO-MATEO trial evaluated the impact of NRS on clinical outcomes for patients with advanced EGA. Patients and methods: Patients enrolled in the MATEO trial (exploring S-1 maintenance therapy) with an available baseline NRS before induction chemotherapy were included. Patients were stratified by their baseline NRS score (<3 versus ≥3). Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan–Meier and Cox regression methods. Results: Of the 136 patients, 86 had an NRS score <3 and 50 had an NRS score ≥3 at baseline. Baseline median European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C30) global health score was lower for the NRS ≥3 group (37.5 versus 58.3). Nutritional interventions were more frequent in the NRS ≥3 group (45.8% versus 10.6%; P < 0.001). Patients with NRS ≥3 had inferior median PFS (4.9 months versus 6.9 months; P = 0.025) and OS (8.2 months versus 13.2 months; P = 0.003). Patients whose NRS score improved during induction chemotherapy showed superior median PFS (7.4 months versus 4.1 months; P = 0.085) and OS (20.1 months versus 8.0 months; P = 0.054) compared with those without improvement. No significant differences in overall toxicity were observed. Conclusions: Baseline NRS is a significant predictor of outcome in patients with metastatic EGA. Our findings underscore the importance of routinely assessing the nutritional status of patients with metastatic EGA and intervening early.