Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
Eur J Surg Oncol. 2024 Oct;50(10):108580. doi: 10.1016/j.ejso.2024.108580. Epub 2024 Aug 2.
The newly released Asian Working Group for Cachexia (AWGC) criteria share similar diagnostic items with the Global Leadership Initiative on Malnutrition (GLIM) criteria. This study aims to compare the AWGC cachexia and GLIM malnutrition in patients with gastric cancer and investigate whether one diagnosis continues to be a prognostic factor in individuals diagnosed with the other condition.
Data of patients who underwent radical gastrectomy for gastric adenocarcinoma were prospectively collected from 2013 to 2019. The AWGC and GLIM criteria were applied to diagnosis cachexia and malnutrition, respectively. Univariate and multivariate logistic and Cox regression were used to verify the effect of relevant factors on postoperative complications and overall survival.
A total of 1420 patients were included, among whom 174 (12.3 %) were diagnosed with AWGC-cachexia alone, 85 (6.0 %) were diagnosed with GLIM-malnutrition alone, and 324 (22.8 %) had both AWGC-cachexia and GLIM-malnutrition. Both AWGC-cachexia and GLIM-malnutrition were independent risk factors for complications and overall survival. When they coexisted, the odds ratios (OR) and hazard ratios (HR) tended to be higher. In the AWGC-cachexia subset, GLIM-malnutrition remained an independent risk factor (HR = 1.544, 95 % CI = 1.098-2.171, P = 0.012) for overall survival after the adjustment of confounding factors. Similarly, in the GLIM-malnutrition subset, AWGC-cachexia remained an independent risk factor for overall survival (HR = 1.697, 95 % CI = 1.087-2.650, P = 0.020). Patients with both cachexia and malnutrition had the worst overall survival.
AWGC-cachexia and GLIM-malnutrition criteria were two non-redundancy tools in reflecting mortality risk in preoperative nutritional assessment.
新发布的亚洲消瘦工作组（AWGC）标准与全球营养不良领导倡议（GLIM）标准具有相似的诊断项目。本研究旨在比较胃癌患者的 AWGC 消瘦和 GLIM 营养不良，并探讨一种诊断是否仍然是另一种情况下个体的预后因素。
从 2013 年到 2019 年，前瞻性收集了接受胃腺癌根治性胃切除术的患者数据。分别应用 AWGC 和 GLIM 标准诊断消瘦和营养不良。采用单因素和多因素逻辑回归和 Cox 回归来验证相关因素对术后并发症和总生存的影响。
共纳入 1420 例患者，其中 174 例（12.3%）被诊断为 AWGC 消瘦，85 例（6.0%）被诊断为 GLIM 营养不良，324 例（22.8%）同时患有 AWGC 消瘦和 GLIM 营养不良。AWGC 消瘦和 GLIM 营养不良均为并发症和总生存的独立危险因素。当它们共存时，比值比（OR）和风险比（HR）往往更高。在 AWGC 消瘦亚组中，GLIM 营养不良在调整混杂因素后仍然是总生存的独立危险因素（HR=1.544，95%CI=1.098-2.171，P=0.012）。同样，在 GLIM 营养不良亚组中，AWGC 消瘦仍然是总生存的独立危险因素（HR=1.697，95%CI=1.087-2.650，P=0.020）。同时患有消瘦和营养不良的患者总生存最差。
AWGC 消瘦和 GLIM 营养不良标准是术前营养评估中反映死亡率风险的两个非冗余工具。
