Liang Yaohao, Lu Zhan, Ruan Tianyu, Wu Shanglin, Meng Jianyi, Jiang Jie, He Jiaqian, Jiang Liyan, Tan Ning, Tan Shengqiang
Department of Hepatobiliary and Pancreatic Surgery, Nanning Ninth People's Hospital, Nanning, China.
Department of Hepatobiliary and Pancreatic Surgery, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China.
Front Nutr. 2025 Jun 26;12:1610066. doi: 10.3389/fnut.2025.1610066. eCollection 2025.
The Global Leadership Initiative on Malnutrition (GLIM) criteria were developed to standardize diagnoses of malnutrition. However, the prognostic utility of the GLIM criteria and predictive models including GLIM criteria in patients diagnosed with hepatocellular carcinoma (HCC) undergoing hepatectomy remains largely unexplored.
This retrospective study included 477 HCC patients who underwent curative hepatectomy at two centers (training cohort: = 297, January 2014 to November 2020; validation cohort: = 180, April 2018 to December 2019). A nomogram was developed using multivariate Cox regression analysis. The utility of the developed model was evaluated by Harrell concordance index (C-index), calibration curve, and decision curve analysis (DCA). Time-dependent receiver operating characteristic (ROC) curves and DCA were used to compare the nomogram with existing prognostic models.
The prevalence of malnutrition was 30.6 and 25.6% in the training and validation cohorts, respectively. Non-malnourished patients exhibited superior overall survival (OS) across all BCLC stages ( < 0.001). Multivariate analysis identified GLIM-diagnosed malnutrition, albumin <35 g/L, tumor size >5 cm, alpha-fetoprotein (AFP) ≥400 ng/mL, and tumor number ≥3 as independent predictors of OS. The nomogram for 3-year OS achieved C-indices of 0.735 and 0.666 in the training and validation cohorts, respectively. External validation demonstrated good discrimination and calibration. The nomogram outperformed the ALBI, PNI, and BCLC staging systems in terms of AUC and DCA.
GLIM-diagnosed malnutrition was an independent risk factor for OS in patients with HCC undergoing hepatectomy. The nomogram including GLIM is a good tool for predicting postoperative OS in this patient population.
全球营养不良领导倡议（GLIM）标准旨在规范营养不良的诊断。然而，GLIM标准以及包含GLIM标准的预测模型在接受肝切除术的肝细胞癌（HCC）患者中的预后效用在很大程度上仍未得到探索。
这项回顾性研究纳入了在两个中心接受根治性肝切除术的477例HCC患者（训练队列：n = 297，2014年1月至2020年11月；验证队列：n = 180，2018年4月至2019年12月）。使用多变量Cox回归分析建立了列线图。通过Harrell一致性指数（C指数）、校准曲线和决策曲线分析（DCA）评估所建立模型的效用。使用时间依赖性受试者工作特征（ROC）曲线和DCA将列线图与现有的预后模型进行比较。
训练队列和验证队列中营养不良的患病率分别为30.6%和25.6%。在所有BCLC分期中，非营养不良患者的总生存期（OS）均更优（P < 0.001）。多变量分析确定GLIM诊断的营养不良、白蛋白<35 g/L、肿瘤大小>5 cm、甲胎蛋白（AFP）≥400 ng/mL和肿瘤数量≥3为OS的独立预测因素。3年OS的列线图在训练队列和验证队列中的C指数分别为0.735和0.666。外部验证显示出良好的区分度和校准度。列线图在AUC和DCA方面优于ALBI、PNI和BCLC分期系统。
GLIM诊断的营养不良是接受肝切除术的HCC患者OS的独立危险因素。包含GLIM的列线图是预测该患者群体术后OS的良好工具。
