Yin Liangyu, Fan Yang, Lin Xin, Zhang Ling, Li Na, Liu Jie, Guo Jing, Zhang Mengyuan, He Xiumei, Liu Lijuan, Zhang Hongmei, Shi Muli, Chong Feifei, Chen Xiao, Wang Chang, Wang Xu, Liang Tingting, Liu Xiangliang, Deng Li, Li Wei, Song Chunhua, Cui Jiuwei, Shi Hanping, Xu Hongxia
Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing400042, People's Republic of China.
Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing400038, People's Republic of China.
Br J Nutr. 2022 May 28;127(10):1506-1516. doi: 10.1017/S0007114521002531. Epub 2021 Jul 5.
The present study evaluated whether fat mass assessment using the triceps skinfold (TSF) thickness provides additional prognostic value to the Global Leadership Initiative on Malnutrition (GLIM) framework in patients with lung cancer (LC). We performed an observational cohort study including 2672 LC patients in China. Comprehensive demographic, disease and nutritional characteristics were collected. Malnutrition was retrospectively defined using the GLIM criteria, and optimal stratification was used to determine the best thresholds for the TSF. The associations of malnutrition and TSF categories with survival were estimated independently and jointly by calculating multivariable-adjusted hazard ratios (HR). Malnutrition was identified in 808 (30·2 %) patients, and the best TSF thresholds were 9·5 mm in men and 12 mm in women. Accordingly, 496 (18·6 %) patients were identified as having a low TSF. Patients with concurrent malnutrition and a low TSF had a 54 % (HR = 1·54, 95 % CI = 1·25, 1·88) greater death hazard compared with well-nourished individuals, which was also greater compared with malnourished patients with a normal TSF (HR = 1·23, 95 % CI = 1·06, 1·43) or malnourished patients without TSF assessment (HR = 1·31, 95 % CI = 1·14, 1·50). These associations were concentrated among those patients with adequate muscle mass (as indicated by the calf circumference). Additional fat mass assessment using the TSF enhances the prognostic value of the GLIM criteria. Using the population-derived thresholds for the TSF may provide significant prognostic value when used in combination with the GLIM criteria to guide strategies to optimise the long-term outcomes in patients with LC.
本研究评估了使用肱三头肌皮褶（TSF）厚度进行脂肪量评估是否能为肺癌（LC）患者的全球营养不良领导倡议（GLIM）框架提供额外的预后价值。我们在中国进行了一项观察性队列研究，纳入了2672例LC患者。收集了全面的人口统计学、疾病和营养特征。采用GLIM标准对营养不良进行回顾性定义，并使用最佳分层法确定TSF的最佳阈值。通过计算多变量调整风险比（HR），分别独立和联合估计营养不良和TSF类别与生存率的关联。808例（30.2%）患者被确定为营养不良，男性TSF的最佳阈值为9.5mm，女性为12mm。据此，496例（18.6%）患者被确定为TSF较低。与营养良好的个体相比，同时存在营养不良和TSF较低的患者死亡风险高54%（HR = 1.54，95%CI = 1.25，1.88），与TSF正常的营养不良患者（HR = 1.23，95%CI = 1.06，1.43）或未进行TSF评估的营养不良患者（HR = 1.31，95%CI = 1.14，1.50）相比也更高。这些关联主要集中在肌肉量充足的患者中（以小腿围表示）。使用TSF进行额外的脂肪量评估可提高GLIM标准的预后价值。当与GLIM标准结合使用以指导优化LC患者长期结局的策略时，采用基于人群得出的TSF阈值可能具有显著的预后价值。
