Institute of Biopharmaceutical, Liaocheng University, Liaocheng, China; Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Oncology, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.
Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Oncology, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.
Nutrition. 2021 Sep;89:111286. doi: 10.1016/j.nut.2021.111286. Epub 2021 Apr 24.
Malnutrition is common and related to negative prognosis in patients with gastric cancer (GC). The Global Leadership Initiative on Malnutrition (GLIM), a novel consensus for the diagnosis of malnutrition, was proposed recently. However, the roles of GLIM in diagnosing malnutrition and predicting overall survival (OS) in patients with GC have been unclear.
We conducted a multicenter, observational cohort study including 877 hospitalized patients with GC 2013 through 2018. Different anthropometric measurements were compared to assess reduced muscle mass. Kaplan-Meier curves and multivariate Cox regression were used to analyze the relationship between GLIM-defined malnutrition and the OS of patients with GC. Independent prognostic variables were incorporated to develop a nomogram for individualized survival prediction. The calibration curve was used to determine the predictive accuracy and discriminatory capacity of the nomogram. In addition, 219 patients with GC were enrolled for external validation.
A total of 464 (53%) patients with GC were diagnosed with malnutrition. Patients diagnosed with severe malnutrition based on either midarm circumference or body weight-standardized hand grip strength had a shorter median survival time (16.7 mo; interquartile range, 8.4-32.7 mo) and a higher hazard ratio (HR, 1.49; 95% CI, 1.15-1.92; P = 0.002). Severe malnutrition was an independent risk factor for OS (HR, 1.32; 95% CI, 1.02-1.71; P = 0.038). The GLIM nomogram showed good performance in predicting 3-y survival in patients with GC.
Our findings support the effectiveness of GLIM in diagnosing malnutrition and predicting OS in patients with GC.
营养不良在胃癌（GC）患者中较为常见，与不良预后相关。最近提出了一种新的营养不良诊断共识，即全球营养不良领导倡议（GLIM）。然而，GLIM 在诊断 GC 患者营养不良和预测总生存期（OS）中的作用尚不清楚。
我们进行了一项多中心、观察性队列研究，纳入了 2013 年至 2018 年期间 877 例住院的 GC 患者。比较了不同的人体测量学测量方法来评估肌肉减少情况。采用 Kaplan-Meier 曲线和多变量 Cox 回归分析 GLIM 定义的营养不良与 GC 患者 OS 之间的关系。纳入独立预后变量以开发用于个体生存预测的列线图。使用校准曲线来确定列线图的预测准确性和区分能力。此外，还纳入了 219 例 GC 患者进行外部验证。
共有 464 例（53%）GC 患者被诊断为营养不良。根据中臂围或体重标准化握力诊断为严重营养不良的患者中位生存时间更短（16.7 个月；四分位距，8.4-32.7 个月），风险比（HR）更高（1.49；95%CI，1.15-1.92；P=0.002）。严重营养不良是 OS 的独立危险因素（HR，1.32；95%CI，1.02-1.71；P=0.038）。GLIM 列线图在预测 GC 患者 3 年生存方面表现良好。
我们的研究结果支持 GLIM 在诊断 GC 患者营养不良和预测 OS 中的有效性。
