GLIM 定义的营养不良对胃癌患者的预后价值

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摘要评估全球营养不良领导倡议(GLIM)标准在胃癌患者中的应用价值,并探讨 GLIM 定义的营养不良与胃癌患者预后的关系。方法选择 2017 年 1 月至 2021 年 12 月在南通大学附属海安医院肿瘤科接受根治性手术切除的 174 例胃癌患者为研究对象,根据 GLIM 标准采用体质指数(BMI)和第三腰椎旁肌肉指数(SMI)作为表现型指标,对所有参与者进行营养状况评估和营养不良诊断。通过 Kaplan-Meier 生存曲线和单、多因素 Cox 回归分析,评估 GLIM 定义的营养不良对胃癌患者预后的影响。结果入院营养筛查显示,174 例胃癌患者中有 80 例(46. 0%)患者存在营养不良风险[营养风险筛查 2002 (NRS 2002)≥3 分]。使用 GLIM 标准进一步诊断,结果发现有 57 例(32. 8%)患者存在术前营养不良,其中 24 例(13. 8%)有 BMI 减低,51 例(29. 3%)有肌肉质量减少。与非营养不良者相比,GLIM 定义的营养不良患者 BMI[ (20. 4 ± 2. 5)kg / m 2比(23. 5 ± 3. 4)kg / m 2 , t = 6. 093, P<0. 001)]、SMI [(37. 9 ± 4. 2)cm 2 / m 2比(46. 2 ± 7. 9) cm 2 / m 2 , t = 7. 424, P<0. 001]、血红蛋白浓度 [(125. 0 ± 18. 0)g / L 比(136. 0 ± 20. 0)g / L, t = 3. 333, P= 0. 001]与血清白蛋白水平[(36. 7 ± 4. 6)比(39. 0 ± 3. 9)g / L, t = 2. 470, P= 0. 014]明显更低。生存分析表明,GLIM 定义的营养不良组与非营养不良患者的 5 年无病生存(DFS) 率分别为 49. 8%和 75. 6% (χ 2 = 7. 502, P= 0. 006)。亚组分析展示,GLIM 定义的营养不良与Ⅲ期胃癌患者低 DFS 明显相关,5 年 DFS 率分别为 31. 7%和 69. 2%,差异有统计学意义(χ 2 = 12. 523, P<0. 001)。此外,单、多因素 Cox 回归分析表明,GLIM 定义的营养不良(HR= 2. 180, 95%CI = 1. 288~ 3. 687, P = 0. 004)、TNM 分期(HR = 2. 216, 95%CI = 1. 245 ~ 3. 947,P = 0. 007)以及 Borrmann 分型(HR= 2. 171, 95%CI = 1. 019~ 4. 624,P= 0. 044)是胃癌患者的独立预后因素。结论 GLIM 标准不仅可以反映胃癌患者的营养状况,还可作为患者预后评价的一项有效预测工具。

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	徐婷婷
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	张燕

关键词 ：胃癌, 全球营养不良领导倡议, 肌肉质量减少, 营养不良, 预后

Abstract：The purpose of this study was to investigate the clinical value of Global Leadership Initiative on Malnutrition GLIM criteria and evaluate the relationship between GLIM-defined malnutrition and survival outcome of gastric cancer patients. Method Totally 174 gastric cancer patients who underwent radical resection at the Department of Gastrointestinal Surgery in our hospital from January 2017 to December 2021were selected as the research participants. Body mass index BMI and the third lumbar skeletal muscle index SMI were used as phenotypic criteria of GLIM consensus for the evaluation of nutritional status and the diagnosis of malnutrition. The effects of GLIM-defined malnutrition on the prognosis of gastric cancer patients were estimated by KaplanMeier method and the univariate and multivariate Cox regression analysis. Result Nutritional risk screening at admission showed that 80 46. 0% of 174 gastric cancer patients were at risk of malnutrition NRS 2002 ≥3 . According to the GLIM criteria it was found that 57 32. 8% of 174 gastric cancer patients were diagnosed with malnutrition before surgery and low BMI was observed in 24 13. 8% patients and reduced muscle mass was observed in 51 29. 3% patients. BMI 20. 4 ± 2. 5 vs 23. 5 ± 3. 4 kg / m 2 t = 6. 093 P<0. 001 SMI 37. 9 ± 4. 2 vs 46. 2 ± 7. 9 cm 2 / m 2 t = 7. 424 P<0. 001 hemoglobin concentration 125. 0 ± 18. 0 vs 136. 0 ± 20. 0 g / L t = 3. 333 P= 0. 001 and serum albumin level 36. 7 ± 4. 6 vs 39. 0 ± 3. 9 g / L t = 2. 470 P= 0. 014 were significantly lower in patients with GLIM-defined malnutrition than in those without malnutrition. Survival analysis indicated that the 5-year disease-free survival DFS rates of patients with and without malnutrition based on the GLIM criteria were 49. 8% and 75. 6% respectively χ 2 = 7. 502 P = 0. 006 . Subgroup analysis showed that GLIM - defined malnutrition was significantly associated with worse DFS of stage Ⅲ patients. The 5 -year DFS rates of patients with and without malnutrition were 31. 7% and 69. 2% with a significantly statistical difference χ 2 = 12. 523 P<0. 001 . In addition the univariate and multivariate Cox regression analysis demonstrated that GLIM - defined malnutrition HR = 2. 180 95% CI = 1. 288 - 3. 687 P = 0. 004 TNM stage HR = 2. 216 95% CI = 1. 245 - 3. 947 P = 0. 007 and Borrmann classification HR = 2. 171 95% CI = 1. 019 - 4. 624 P = 0. 044 were independent prognostic factors for gastric cancer patients. Conclusion GLIM criteria could reflect the nutritional status of gastric cancer patients and it could be used as an effective tool for prognostic assessment.

Key words： Gastric cancer, Global Leadership Initiative on Malnutrition Reduced muscle mass, Malnutrition, Prognosis

基金资助:南通市科技计划项目(MSZ18232)

通讯作者: 徐婷婷,电子邮箱:haian15750@ 163. com

引用本文:

徐婷婷,王陈晨,陆滢滢,张燕. GLIM 定义的营养不良对胃癌患者的预后价值[J/CD] . 肿瘤代谢与营养电子杂志, 2022, 9(6): 786-793.
Xu Tingting, Wang Chenchen,Lu Yingying,Zhang Yan. Prognostic value of the Global Leadership Initiative on Malnutrition GLIM -defined malnutrition for gastric cancer patients. Electron J Metab Nutr Cancer, 2022, 9(6): 786-793.