The Relationship Between Nutritional Status and the Glasgow Prognostic Score in Patients with Cancer of the Esophagus and Stomach

Abstract

A relationship between weight loss and inflammation has been described in patients with cancer. In the present study, the relationship between subjective global assessment (SGA) and the severity of inflammation, as defined by Glasgow prognostic score (GPS), as well as the relationship of both of these measures with the presence of complications and survival time, was assessed. In addition, we compared the diagnosis given by SGA with parameters of nutritional assessment, such as body mass index, triceps skinfold, midarm circumference (MAC), midarm muscle circumference (MAMC), phase angle (PA), adductor pollicis muscle thickness (APMT), and handgrip strength (HGS). According to the SGA, the nutritional status was associated with the GPS (P < 0.05), and both the SGA and GPS were associated with the presence of complications. However, the GPS [area under the curve (AUC): 0.77, P < 0.05, confidence interval (CI) = 0.580, 0.956] seems to be more accurate in identifying complications than the SGA (AUC: 0.679, P < 0.05, CI = 0.426, 0.931). Only GPS was associated with survival time. Comparing the different nutritional assessment methods with the SGA suggested that the MAC, MAMC, APMT, PA, and HGS parameters may be helpful in differentiating between nourished and malnourished patients, if new cutoffs are adopted.

Nutritional assessment methods as predictors of postoperative mortality in gastric cancer patients submitted to gastrectomy

“…Paceli et al 28 found a preoperative weight loss greater than 10% in 42% of gastric cancer patients, similar to those of other Asian studies, of 13% and 31% 6,7 , respectively. However, this incidence may increase to 81% in the postoperative period, which confirms that gastrectomy significantly affects nutrition 20,29 .…”

“…A Brazilian group found a relationship between PGSGA and GPS, and both measures were associated with postoperative complications and survival in patients with esophageal and stomach cancer 29 . An ongoing study in our research group is evaluating the role of GPS as a short-term predictor of worsening nutritional status and postoperative complications.…”

Nutritional Management of Esophageal Cancer Patients

“…For example, Subjective Global Assessment (SGA), a questionnaire based on four parameters of patient's history (percentage of weight loss, changes in habitual diet, presence of significant gastrointestinal symptoms, and changes in patient's functional capacity) and three elements of their physical examination (loss of subcutaneous fat, muscle wasting, and presence of edema or ascites) is one the most commonly used tool for nutritional screening in malnourished hospital patients with cancer. SGA is strongly correlated with performance status in esophageal cancer patients [16] as well as with The Glasgow prognostic score and with complications during cancer treatment [23]. Other tools that have been studied in cancer patients is the Prognostic Nutritional Index (PNI), the Nutritional Risk Screening 2002 (NRS 2002), the Controlling Nutritional Status (CONUT) and the Nutritional Risk Index (NRI).…”

Energy Expenditure in Patients With Esophageal, Gastric, and Colorectal Cancer

“…Tumors located in different portions of the gastrointestinal tract are among the most common in the world, and the associated risk factors are changes in the lifestyle of modern society, characterized by the interaction between alcoholism, smoking, obesity, physical inactivity, and poor diet, with high consumption of nitrates and low fiber intake 3 , 4 . Nutritional depletion is a common diagnosis, and it has been related to worse outcomes and cancer progression 5 . ‐ 7…”