Nutritional Support for Treatment Continuity and Survival in Advanced Gastric Cancer: A Propensity Score-matched Study

BACKGROUND/AIM: This study aimed to clarify the effect of nutritional support in patients with advanced gastric cancer (AGC) receiving first-line chemotherapy. PATIENTS AND METHODS: We retrospectively reviewed the medical records of consecutive patients with unresectable or recurrent AGC treated with first-line chemotherapy at Nagoya Medical Center between 2007 and 2024. Patients who received nutritional support were compared with those without nutritional support. Nutritional support included individualized dietary counselling, assessment of energy and protein requirements, and multidisciplinary evaluation. Propensity score matching (PSM, 1:1) was applied to adjust for baseline nutritional and inflammatory status. The primary endpoint was time to treatment failure (TTF). Subgroup analyses were conducted by baseline albumin level. RESULTS: Among the 324 eligible patients included in the analysis, 76 received nutritional support. Before PSM, patients who were provided nutritional support more frequently presented with poor nutritional profiles. After PSM (n=46 per group), the median TTF was 5.0 months in patients without nutritional support and 4.6 months in those with it. In patients with hypoalbuminemia (albumin <3.5 g/dl), nutritional support significantly prolonged TTF. Finally, multivariate analysis in the pre-PSM cohort identified nutritional support as an independent predictor of TTF. CONCLUSION: Although nutritional support was not associated with significant TTF improvement in the overall AGC population after propensity score matching, it emerged as an independent predictor of treatment continuity in multivariate analysis of the pre-PSM cohort. This benefit was particularly evident in patients with hypoalbuminemia, indicating that targeted nutritional intervention is essential for this vulnerable subgroup to prevent premature treatment failure.