GLIM 标准诊断的营养不良对肝癌肝切除术后结局的影响。

Impact of GLIM criteria-based malnutrition diagnosis on outcomes following liver resection for hepatocellular carcinoma.

机构信息

Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.

出版信息

HPB (Oxford). 2023 Dec;25(12):1555-1565. doi: 10.1016/j.hpb.2023.08.012. Epub 2023 Aug 25.

DOI:10.1016/j.hpb.2023.08.012

PMID:37684130

Abstract

BACKGROUND

The Global Leadership Initiative on Malnutrition (GLIM), comprising several of the major global clinical nutrition societies, suggested the world's first criteria for diagnosis of the severity of malnutrition. However, the impact of the resulting diagnosis on patient outcomes for those with hepatocellular carcinoma (HCC) following liver resection (LR) has not been investigated.

METHODS

A retrospective analysis of 293 patients with HCC who underwent LR between January 2011 and December 2018 was performed. We compared overall survival (OS) and recurrence-free survival (RFS) and evaluated prognostic factors after LR using Cox proportional hazards regression models.

RESULTS

Preoperative patient nutritional status, n (%), was classified as follows: normal, 130 (44%), moderate malnutrition, 116 (40%), and severe malnutrition, 47 (16%). The median OS (129 vs. 43 months, p < 0.001) and median RFS (54 vs. 20 months, p = 0.001) were significantly greater in the normal group than in the severe malnutrition group. Multivariate analysis showed that severe malnutrition was a significant risk factor for OS (p = 0.006) and RFS (p = 0.010) after initial LR.

CONCLUSION

Severe malnutrition, as diagnosed by the GLIM criteria, is a significant prognostic factor for survival and recurrence in patients with HCC after LR.

摘要

背景

全球营养不良领导倡议（GLIM）由多个主要的全球临床营养学会组成，提出了世界上第一个用于诊断营养不良严重程度的标准。然而，尚未研究由此导致的诊断对接受肝切除（LR）的肝细胞癌（HCC）患者的预后的影响。

方法

对 2011 年 1 月至 2018 年 12 月期间接受 LR 的 293 例 HCC 患者进行回顾性分析。我们比较了总生存率（OS）和无复发生存率（RFS），并使用 Cox 比例风险回归模型评估 LR 后的预后因素。

结果

术前患者营养状况，n（%）如下：正常，130（44%），中度营养不良，116（40%）和严重营养不良，47（16%）。正常组的中位 OS（129 比 43 个月，p <0.001）和中位 RFS（54 比 20 个月，p = 0.001）均显著长于严重营养不良组。多变量分析表明，严重营养不良是初始 LR 后 OS（p = 0.006）和 RFS（p = 0.010）的显著危险因素。