Igarashi Takamichi, Harimoto Norifumi, Fukushima Ryosuke, Hagiwara Kei, Hoshino Kouki, Kawai Shunsuke, Ishii Norihiro, Tsukagoshi Mariko, Araki Kenichiro, Shirabe Ken
Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
Surg Today. 2025 Jun;55(6):830-838. doi: 10.1007/s00595-024-02970-3. Epub 2024 Dec 2.
This study investigated the significance of the Global Leadership Initiative on Malnutrition (GLIM) for patients with resected biliary tract cancers.
The subjects of this retrospective analysis were 114 patients who underwent radical surgery for cholangiocarcinoma between 2018 and 2023. We analyzed both handgrip force and skeletal muscle area and classified patients as having GLIM malnutrition or modified GLIM malcondition. We also evaluated clinicopathological factors, short-term outcomes, and prognoses.
The GLIM criteria identified 47 patients (41.2%) with malnutrition and 13 patients (11.4%) with modified GLIM malcondition. Overall survival (P = 0.009) and recurrence-free survival (P = 0.016) were significantly different between the well-nourished and malnourished patients according to the GLIM criteria. Furthermore, modified GLIM criteria malcondition was a significant prognostic factor for both recurrence-free and overall survival (P = 0.002 and P < 0.001, respectively). Multivariate analysis identified a higher carcinoembryonic antigen level and modified GLIM malcondition as predictors of overall and recurrence-free survival. Pathological stage ≥ III was also a predictor of recurrence-free survival. On comparing the prognoses of modified GLIM malcondition and GLIM malnutrition using the Akaike Information Criteria, the modified GLIM malcondition was identified as a stronger prognostic factor.
A modified GLIM malcondition can be a highly useful prognostic marker for patients with resected biliary tract cancer.
本研究调查了全球营养不良领导倡议（GLIM）对接受胆管癌切除术患者的意义。
本回顾性分析的对象为2018年至2023年间接受胆管癌根治性手术的114例患者。我们分析了握力和骨骼肌面积，并将患者分类为患有GLIM营养不良或改良GLIM身体状况不佳。我们还评估了临床病理因素、短期结局和预后。
根据GLIM标准，47例患者（41.2%）被确定为营养不良，13例患者（11.4%）被确定为改良GLIM身体状况不佳。根据GLIM标准，营养良好和营养不良患者的总生存期（P = 0.009）和无复发生存期（P = 0.016）存在显著差异。此外，改良GLIM标准身体状况不佳是无复发生存期和总生存期的重要预后因素（分别为P = 0.002和P < 0.001）。多因素分析确定癌胚抗原水平升高和改良GLIM身体状况不佳是总生存期和无复发生存期的预测因素。病理分期≥III也是无复发生存期的预测因素。使用赤池信息准则比较改良GLIM身体状况不佳和GLIM营养不良的预后，改良GLIM身体状况不佳被确定为更强的预后因素。
改良GLIM身体状况不佳可为接受胆管癌切除术的患者提供非常有用的预后标志物。
