Association of GLIM Defined Malnutrition According to Preoperative Chronic Inflammation with Long-Term Prognosis after Gastrectomy in Patients with Advanced Gastric Cancer

Abstract

This study aimed to investigate the association of malnutrition, defined by the Global Leadership Initiative on Malnutrition (GLIM) according to preoperative chronic inflammation with long-term prognosis after gastrectomy in patients with advanced gastric cancer. We included patients with primary stage I-III gastric cancer who underwent gastrectomy between April 2008 and June 2018. Patients were categorized as normal, moderate malnutrition, and severe malnutrition. Preoperative chronic inflammation was defined as a C-reactive protein level of >0.5 mg/dL. The primary endpoint was overall survival (OS), compared between the inflammation and non-inflammation groups. Among the 457 patients, 74 (16.2%) and 383 (83.8%) were included in the inflammation and non-inflammation groups, respectively. The prevalence of malnutrition was similar in both groups (p = 0.208). Multivariate analyses for OS showed that moderate malnutrition (hazard ratios: 1.749, 95% concordance interval: 1.037–2.949, p = 0.036) and severe malnutrition (hazard ratios: 1.971, 95% CI: 1.130–3.439, p = 0.017) were poor prognostic factors in the non-inflammation group, but malnutrition was not a prognostic factor in the inflammation group. In conclusion, preoperative malnutrition was a poor prognostic factor in patients without inflammation, but it was not a prognostic factor in patients with inflammation.

Exploring the association between inflammatory biomarkers and gastric cancer development: A two-sample mendelian randomization analysis.

“…On the one hand, the progression of gastric malignancy is intimately associated with chronic gastritis, a persistent inflammation of the gastric mucosa typically due to H pylori infection, longterm NSAID use, or other etiological factors. [52][53][54] Chronic gastritis can precipitate a series of changes in the gastric mucosa that may culminate in intestinal metaplasia, atypical hyperplasia, and eventually, gastric malignancy. On the other hand, an imbalance in the production and regulation of inflammatory mediators is thought to play a pivotal role in the pathogenesis of gastric malignancies.…”

Adipose Tissue Quantification Improves the Prognostic Value of GLIM Criteria in Advanced Gastric Cancer Patients

“…To overcome this problem, the Global Leadership Initiative on Malnutrition (GLIM) criteria, which comprises two diagnostic assessment criteria, phenotypic (weight, body mass index, and muscle mass) and etiologic (food intake and inflammation), have been proposed as a global consensus for diagnosing malnutrition in adults [ 7 ]. Based on the GLIM criteria, malnutrition is found to be quite common in patients with gastric cancer, showing incidence rates between 36.3 and 69.2% [ 6 , 8 , 9 ]. In addition, among patients with gastric cancer, those who were malnourished before treatment showed significantly worse prognoses than those with no malnutrition [ 6 , 9 , 10 ].…”