Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of General Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Eur J Clin Nutr. 2022 Sep;76(9):1323-1331. doi: 10.1038/s41430-022-01109-2. Epub 2022 Mar 21.
The present study aims to investigate whether malnutrition defined by the Global Leadership Initiative in Malnutrition (GLIM) criteria using hand-grip strength (HGS) adequately predict postoperative complications and long-term survival in patients underwent radical gastrectomy for gastric cancer in a similar manner to GLIM-defined malnutrition using skeletal muscle index (SMI).
Patients who underwent radical gastrectomy for gastric cancer from August 2014 to June 2019 were included in this study. Clinical data were prospectively collected. Malnutrition was diagnosed based on the two-step approach following the GLIM criteria. Skeletal muscle mass was assessed using SMI based on abdominal computed tomography (CT) scans, or assessed using HGS.
A total of 1359 patients were included in this study, in which 36.2% of the patients were at risk of malnutrition (Nutritional Risk Screening 2002 scores ≥3). The incidence of malnutrition was 28.2% and 27.5% using SMI and HGS, respectively. There was a high agreement between the two criteria of malnutrition (kappa = 0.863, P < 0.001). Both of the two criteria of malnutrition were independently associated with postoperative complications (SMI-GLIM, P = 0.041; HGS-GLIM, P = 0.023), overall survival (P < 0.001, both), and disease-free survival (P < 0.001, both), with similar odds ratio or hazard ratio after adjusting for the same confounding variables. HGS-GLIM malnutrition (P = 0.046) but not SMI-GLIM malnutrition (P = 0.270) was associated with a higher incidence of severe complications.
GLIM criteria using HGS is a useful tool to diagnose malnutrition and has a similar or even better predictive value for postoperative complications and long-term survival after radical gastrectomy for gastric cancer compared with GLIM criteria using SMI.
本研究旨在探讨使用握力（HGS）定义的全球营养不良倡议（GLIM）标准是否能够像使用骨骼肌指数（SMI）定义的 GLIM 营养不良一样，充分预测接受胃癌根治性胃切除术的患者的术后并发症和长期生存。
本研究纳入了 2014 年 8 月至 2019 年 6 月期间接受胃癌根治性胃切除术的患者。前瞻性收集临床资料。根据 GLIM 标准的两步法诊断营养不良。使用腹部 CT 扫描评估骨骼肌量，或使用 HGS 评估骨骼肌量。
本研究共纳入 1359 例患者，其中 36.2%的患者存在营养不良风险（营养风险筛查 2002 评分≥3）。使用 SMI 和 HGS 诊断的营养不良发生率分别为 28.2%和 27.5%。两种营养不良标准之间具有高度一致性（kappa=0.863，P<0.001）。两种营养不良标准均与术后并发症独立相关（SMI-GLIM，P=0.041；HGS-GLIM，P=0.023）、总生存（P<0.001，均）和无病生存（P<0.001，均），调整相同混杂变量后，比值比或风险比相似。HGS-GLIM 营养不良（P=0.046）而非 SMI-GLIM 营养不良（P=0.270）与严重并发症的发生率较高相关。
使用 HGS 的 GLIM 标准是一种诊断营养不良的有用工具，与使用 SMI 定义的 GLIM 标准相比，其对胃癌根治性胃切除术后的术后并发症和长期生存具有相似或甚至更好的预测价值。
