Zhou Xuan, Yin Kailai, Hong Huanhuan, Yi Heqing, Li Linfa
Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou 310022, China.
Department of Nuclear Medicine, Zhejiang Cancer Hospital, Hangzhou 310022, China.
Curr Oncol. 2025 Jun 19;32(6):363. doi: 10.3390/curroncol32060363.
The Global Leadership Initiative on Malnutrition (GLIM) criteria provide a standardized approach for assessing the nutritional status of patients and demonstrate strong predictive value for the prognosis of patients with gastric cancer. However, these criteria do not incorporate indicators of adipose tissue metabolic activity, which may reflect pro-tumor microenvironmental factors. This study investigated the combined predictive value of malnutrition, defined by the GLIM criteria, and preoperative adipose tissue F-fluorodeoxyglucose (F-FDG) uptake for recurrence-free survival (RFS) in patients with gastric cancer following radical surgery.
A total of 105 patients were retrospectively enrolled and classified into malnourished and non-malnourished groups based on the GLIM criteria. Preoperative F-FDG positron emission tomography/computed tomography (F-FDG PET/CT) was used to measure the mean standardized uptake value (SUVmean) of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). The predictive values of these indicators for RFS in patients with gastric cancer were assessed.
Multivariate survival analysis was used to identify GLIM-defined malnutrition ( = 0.020) and increased preoperative VAT SUVmean ( = 0.042) as independent risk factors for RFS. The combined analysis revealed that patients with both malnutrition and a high preoperative VAT SUVmean had the poorest RFS (HR = 18.41, < 0.001). The predictive model integrating GLIM criteria and VAT SUVmean outperformed the GLIM criteria alone.
This study demonstrated that combining malnutrition defined by the GLIM criteria with preoperative visceral adipose tissue F-FDG uptake optimizes recurrence risk stratification and exhibits superior prognostic predictive efficacy compared to using the GLIM criteria alone. This approach provides new insights into individualized prognostic assessment and intervention strategies.
全球营养不良领导倡议（GLIM）标准为评估患者营养状况提供了标准化方法，并对胃癌患者的预后显示出强大的预测价值。然而，这些标准未纳入脂肪组织代谢活动指标，而该指标可能反映促肿瘤微环境因素。本研究调查了根据GLIM标准定义的营养不良与术前脂肪组织氟脱氧葡萄糖（F-FDG）摄取对胃癌根治术后患者无复发生存期（RFS）的联合预测价值。
共回顾性纳入105例患者，根据GLIM标准分为营养不良组和非营养不良组。术前使用F-FDG正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）测量内脏脂肪组织（VAT）和皮下脂肪组织（SAT）的平均标准化摄取值（SUVmean）。评估这些指标对胃癌患者RFS的预测价值。
多因素生存分析确定GLIM定义的营养不良（P = 0.020）和术前VAT SUVmean升高（P = 0.042）为RFS的独立危险因素。联合分析显示，同时存在营养不良和术前VAT SUVmean高的患者RFS最差（HR = 18.41，P < 0.001）。整合GLIM标准和VAT SUVmean的预测模型优于单独使用GLIM标准。
本研究表明，将GLIM标准定义的营养不良与术前内脏脂肪组织F-FDG摄取相结合可优化复发风险分层，与单独使用GLIM标准相比，具有更好的预后预测效能。该方法为个体化预后评估和干预策略提供了新见解。
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