基于肌肉量和/或力量的全球肌少症领导力倡议（GLIS）标准预测癌症患者生存的潜在框架：一项全国性多中心队列研究。

Potential framework of the Global Leadership Initiative in Sarcopenia (GLIS) criteria based on muscle mass and/or strength for predicting survival in cancer patients: A nationwide multicenter cohort study.

作者信息

Huo Zhenyu, Chong Feifei, Luo Siyu, Li Na, Tong Ning, Lu Zongliang, Guo Jing, Zhang Ling, Lin Xin, Zhang Mengyuan, Zhang Hongmei, Shi Muli, He Xiumei, Liu Jie, Song Chunhua, Shi Hanping, Xu Hongxia

机构信息

Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China; Chongqing Municipal Health Commission Key Laboratory of Intelligent Clinical Nutrition and Transformation, Chongqing, 400042, China.

Department of Clinical Nutrition, The Thirteenth People's Hospital of Chongqing, Chongqing, 400053, China.

出版信息

Clin Nutr. 2025 Jun;49:187-201. doi: 10.1016/j.clnu.2025.04.021. Epub 2025 Apr 24.

DOI:10.1016/j.clnu.2025.04.021

PMID:40344922

Abstract

BACKGROUND

The Global Leadership Initiative on Sarcopenia (GLIS) was proposed recently by creating a widely recognized conceptual definition of sarcopenia, however, the diagnostic framework of GLIS in cancer patients remains unclear. This study aims to evaluate the potential framework of GLIS based on muscle mass and/or strength in cancer patients.

METHODS

We performed a multicenter cohort study spanning from November 2012 to May 2020. Potential covariates were identified through univariate and multivariate analyses. The association between low muscle mass (LMM) and/or low muscle strength (LMS) with survival was estimated using Kaplan-Meier curves and Cox models. LMM was identified by lean mass index (LMI) or calf circumference (CC) while LMS was identified by hand grip strength (HGS).

RESULTS

A total of 6471 cancer patients were included, with a median follow-up of 50.0 months. Both LMM-LMI or LMS (HR = 1.56; 95%CI: 1.42, 1.71; p < 0.001) and LMM-LMI plus LMS (HR = 2.01; 95%CI: 1.65, 2.44; p < 0.001) were associated with a lower overall survival (OS) compared with patients without sarcopenia. Similarly, both LMM-CC or LMS group (HR = 1.51; 95%CI: 1.37, 1.67; p < 0.001) and LMM-CC plus LMS group (HR = 1.45; 95%CI: 1.28, 1.63; p < 0.001) were associated with a lower OS. Age, alcohol, Nutritional Risk Screening 2002 (NRS2002) score, Karnofsky Performance Status (KPS) score, Tumor Node Metastasis (TNM) stage, cancer category, albumin, direct bilirubin, anticancer therapy plus sex were introduced as covariates in fully-adjusted Cox model. Multivariable-adjusted Cox models revealed that LMM-LMI or LMS was an independent prognosis factor for cancer patients (HR = 1.18; 95%CI: 1.07, 1.31; p = 0.001). LMM-LMI plus LMS also was an independent predictor for survival among cancer patients (HR = 1.58; 95 % CI: 1.30, 1.94; p < 0.001).

CONCLUSION

The potential framework of GLIS based on muscle mass and/or strength was associated with survival in Chinese cancer patients. This research provides a simplified, clinically outcome-driven potential framework of sarcopenia, and offers new insights for the development of an operational definition of GLIS in the future.

摘要

背景

全球肌少症领导力倡议（GLIS）最近通过创建一个广泛认可的肌少症概念定义而被提出，然而，GLIS在癌症患者中的诊断框架仍不明确。本研究旨在评估基于癌症患者肌肉质量和/或力量的GLIS潜在框架。

方法

我们进行了一项从2012年11月至2020年5月的多中心队列研究。通过单变量和多变量分析确定潜在的协变量。使用Kaplan-Meier曲线和Cox模型估计低肌肉质量（LMM）和/或低肌肉力量（LMS）与生存率之间的关联。LMM通过瘦体重指数（LMI）或小腿围（CC）确定，而LMS通过握力（HGS）确定。

结果

共纳入6471例癌症患者，中位随访时间为50.0个月。与无肌少症的患者相比，LMM-LMI或LMS组（HR = 1.56；95%CI：1.42，1.71；p < 0.001）以及LMM-LMI加LMS组（HR = 2.01；95%CI：1.65，2.44；p < 0.001）的总生存期（OS）均较低。同样，LMM-CC或LMS组（HR = 1.51；95%CI：1.37，1.67；p < 0.001）以及LMM-CC加LMS组（HR = 1.45；95%CI：1.28，1.63；p < 0.001）的OS也较低。年龄、饮酒、2002年营养风险筛查（NRS2002）评分、卡氏功能状态（KPS）评分、肿瘤淋巴结转移（TNM）分期、癌症类别、白蛋白、直接胆红素、抗癌治疗以及性别作为协变量纳入完全调整的Cox模型。多变量调整的Cox模型显示，LMM-LMI或LMS是癌症患者的独立预后因素（HR = 1.18；95%CI：1.07，1.31；p = 0.001）。LMM-LMI加LMS也是癌症患者生存的独立预测因素（HR = 1.58；95%CI：1.30，1.94；p < 0.001）。