Orell Helena Kristiina, Pohju Anne Katariina, Osterlund Pia, Schwab Ursula Sonja, Ravasco Paula, Mäkitie Antti
Clinical Nutrition Unit, Internal Medicine and Rehabilitation, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
Front Nutr. 2022 Nov 22;9:1030619. doi: 10.3389/fnut.2022.1030619. eCollection 2022.
This study aimed to determine the prevalence of malnutrition in a head and neck cancer (HNC) population according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and to assess its relation to survival. The secondary aim was to compare GLIM criteria to Patient-Generated Subjective Global Assessment (PG-SGA) and Nutritional Risk Screening 2002 (NRS 2002) methods.
The assessment was performed in a series of 65 curative patients with newly diagnosed HNC in a nutrition intervention study. Malnutrition was defined as PG-SGA classes BC and nutritional risk as NRS 2002 score ≥3 and was retrospectively diagnosed with GLIM criteria in prospectively collected data at diagnosis. Sensitivity, specificity, and kappa (κ) were analyzed. Predictive accuracy was assessed by calculating the area under curve (AUC) b y receiver operating characteristic (ROC) analysis. Kaplan-Meier and Cox regression analyses were used to evaluate association between malnutrition and overall survival (OS), and disease-free survival (DFS).
GLIM-defined malnutrition was present in 37% (24/65) of patients. The GLIM showed 77% sensitivity and 84% specificity with agreement of κ = 0.60 and accuracy of AUC = 0.80 ( < 0.001) with PG-SGA and slightly higher sensitivity (83%) with NRS 2002 (κ = 0.58). Patients with GLIM-defined malnutrition had shorter OS (56 vs. 72 months, HR 2.26, 95% CI 1.07-4.77, = 0.034) and DFS (37 vs. 66 months, HR 2.01, 95% CI 0.99-4.09, = 0.054), than well-nourished patients. The adjusted HR was 2.53 (95% CI 1.14-5.47, = 0.023) for OS and 2.10 (95% CI 0.98-4.48, = 0.056) for DFS in patients with GLIM-defined malnutrition.
A substantial proportion of HNC patients were diagnosed with malnutrition according to the GLIM criteria and this showed a moderate agreement with NRS 2002- and PG-SGA-defined malnutrition. Even though the GLIM criteria had strong association with OS, its diagnostic value was poor. Therefore, the GLIM criteria seem potential for malnutrition diagnostics and outcome prediction in the HNC patient population. Furthermore, NRS 2002 score ≥3 indicates high nutritional risk in this patient group.
本研究旨在根据全球营养不良领导倡议（GLIM）标准确定头颈癌（HNC）患者群体中营养不良的患病率，并评估其与生存率的关系。次要目的是将GLIM标准与患者主观整体评定法（PG-SGA）和营养风险筛查2002（NRS 2002）方法进行比较。
在一项营养干预研究中，对65例新诊断的接受根治性治疗的HNC患者进行了评估。营养不良定义为PG-SGA的BC级，营养风险定义为NRS 2002评分≥3，并在诊断时前瞻性收集的数据中采用GLIM标准进行回顾性诊断。分析了敏感性、特异性和kappa（κ）值。通过受试者操作特征（ROC）分析计算曲线下面积（AUC）来评估预测准确性。采用Kaplan-Meier和Cox回归分析评估营养不良与总生存期（OS）和无病生存期（DFS）之间的关联。
37%（24/65）的患者存在GLIM定义的营养不良。GLIM标准与PG-SGA相比，敏感性为77%，特异性为84%，κ值为0.60，AUC准确性为0.80（P<0.001），与NRS 2002相比敏感性略高（83%）（κ=0.58）。与营养良好的患者相比，GLIM定义的营养不良患者的OS（56个月对72个月，HR 2.26，95%CI 1.07-4.77，P=0.034）和DFS（37个月对66个月，HR 2.01，95%CI 0.99-4.09，P=0.054）较短。GLIM定义的营养不良患者的OS校正后HR为2.53（95%CI 1.14-5.47，P=0.023），DFS校正后HR为2.10（95%CI 0.98-4.48，P=0.056）。
根据GLIM标准，相当一部分HNC患者被诊断为营养不良，这与NRS 2002和PG-SGA定义的营养不良有中度一致性。尽管GLIM标准与OS有很强的关联，但其诊断价值较差。因此，GLIM标准在HNC患者群体的营养不良诊断和预后预测方面似乎具有潜力。此外，NRS 2002评分≥表明该患者群体存在高营养风险。
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