Global leaders malnutrition initiative-defined malnutrition affects long-term survival of different subgroups of patients with gastric cancer: A propensity score-matched analysis

Abstract

As defined by the Global Leaders Malnutrition Initiative (GLIM), malnutrition is strongly associated with a lower quality of life and poor prognosis in gastric cancer patients. However, few studies have precisely explored the predictors of malnutrition, as defined by the GLIM, for overall survival (OS) after gastric cancer surgery in subgroups of patients stratified according to population characteristics. Our research aimed to analyze whether the predictors of malnutrition defined by the GLIM for postoperative OS in gastric cancer patients differ across subgroups. Patients who underwent radical gastric cancer surgery at our center between July 2014 and February 2019 were included in the study. Propensity score matching (PSM) was used to minimize bias. The study population was divided into malnourished and normal groups based on whether they were malnourished as defined by the GLIM. Univariate and multivariate analyses were performed to identify the risk factors affecting OS. The Kaplan–Meier curve and log-rank test were performed to determine the survival rate difference between subgroups. Overall, 1,007 patients were enrolled in the research. Multivariate analysis showed that malnutrition among the patients was 33.47%. Additionally, GLIM-defined malnutrition was an independent risk factor [hazard ratio (HR): 1.429, P = 0.001] for a shorter OS in gastric cancer patients. Furthermore, subgroup analysis showed that the GLIM was more appropriate for predicting OS in older aged patients (≥65 years), females, those with comorbidities (Charlson comorbidity index ≥ 2), and those with advanced gastric cancer (TNM stage = 3). GLIM-defined malnutrition affects the long-term survival of gastric cancer patients, especially older patients, females, patients with comorbidities, and patients with advanced gastric cancer.

Nutritional risk index predicts the prognosis of gastric cancer patients with pyloric stenosis who received preoperative parenteral nutrition

“…The causes of malnutrition in patients with gastric cancer with pyloric stenosis were multiple, mainly related to feeding difficulties and disease progression ( 26 – 30 ). The present study indicated that patients with pyloric stenosis were more prone to abdominal distension and higher TNM stage, which were the main reasons for malnutrition and shorter survival ( 31 – 34 ). The NRI contains ALB levels and body weight, which are closely related to the prognosis of patients with gastric cancer ( 35 – 37 ).…”

The relationship between GLIM-malnutrition, post-operative complications and long-term prognosis in elderly patients undergoing colorectal cancer surgery

“…Univariate and multivariate COX regression analyses revealed that GLIM-malnutrition (OR: 2.144, 95% CI: 1.234–3.728, P=0.007) was an independent risk factor for OS in older CRC patients. Likewise, GLIM-malnutrition was reported to be an independent risk factor for OS in patients with gastric cancer ( 25 ). Orell et al pointed out that among head and neck cancer patients, patients with GLIM-malnutrition had a shorter median survival time than well-nourished patients (57 vs. 72 months) ( 26 ).…”

Best Practices for Managing Patients with Unresectable Metastatic Gastric and Gastroesophageal Junction Cancer in Canada

“…Low muscle mass is strongly correlated with malnutrition and should be taken into consideration when evaluating the nutritional status of patients with GC and GEJC [38]. The presence of sarcopenia can lead to poor long-term prognoses for patients undergoing surgery for upper GC [14][15][16][17][38][39][40][41]. Therefore, gaining an understanding of patients' dietary intake, factors affecting the ability to eat and/or absorb nutrients, reduced muscle mass, and muscle function are important considerations in addition to weight loss.…”