Liangyu Yin1,2, Xin Lin1, Na Li1, Mengyuan Zhang1, Xiumei He1, Jie Liu1, Jun Kang3, Xiao Chen4, Chang Wang4, Xu Wang4, Tingting Liang4, Xiangliang Liu4, Li Deng4, Wei Li4, Chunhua Song5, Jiuwei Cui4, Hanping Shi6, Hongxia Xu1. 1. Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China. 2. Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China. 3. Department of Respiratory and Critical Medicine, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China. 4. Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, China. 5. Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China. 6. Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Abstract
BACKGROUND: Malnutrition is prevalent in lung cancer (LC) patients, yet there are no globally accepted criteria for diagnosing malnutrition. Recently, the Global Leadership Initiative on Malnutrition (GLIM) criteria were proposed. However, the role of these criteria in prospective LC cohorts remains unclear. METHODS: We performed a multicenter, observational cohort study including 1219 LC patients. Different anthropometric measures were compared for assessment of reduced muscle mass (RMM) in the GLIM criteria. Least absolute shrinkage and selection operator and multivariate Cox regressions were performed to analyze the association between the GLIM criteria and survival. Independent prognostic predictors were incorporated to develop a nomogram for individualized survival prediction, and decision curve was applied to assess the clinical significance of the nomogram. RESULTS: Patients in the stage II (severe) malnutrition group, diagnosed using combined calf circumference (CC) plus body weight-standardized handgrip strength (HGS/W) criteria, had the highest hazard ratio (HR, 2.07; 95%CI, 1.50-2.86) compared with other methods used to evaluate RMM. The GLIM criteria diagnosed malnutrition in 24% of cases (292 patients, using the CC and HGS/W criteria) and were effective for determining the nutrition status of LC patients. GLIM-diagnosed malnutrition was an independent risk factor for survival, and malnutrition severity was monotonically associated with death hazards (P = .002). The GLIM nomogram showed good performance in predicting the survival of LC patients, and the decision-curve analysis demonstrated that the nomogram was clinically useful. CONCLUSION: These findings support the effectiveness of GLIM in diagnosing malnutrition and predicting survival among LC patients.
BACKGROUND:Malnutrition is prevalent in lung cancer (LC) patients, yet there are no globally accepted criteria for diagnosing malnutrition. Recently, the Global Leadership Initiative on Malnutrition (GLIM) criteria were proposed. However, the role of these criteria in prospective LC cohorts remains unclear. METHODS: We performed a multicenter, observational cohort study including 1219 LC patients. Different anthropometric measures were compared for assessment of reduced muscle mass (RMM) in the GLIM criteria. Least absolute shrinkage and selection operator and multivariate Cox regressions were performed to analyze the association between the GLIM criteria and survival. Independent prognostic predictors were incorporated to develop a nomogram for individualized survival prediction, and decision curve was applied to assess the clinical significance of the nomogram. RESULTS:Patients in the stage II (severe) malnutrition group, diagnosed using combined calf circumference (CC) plus body weight-standardized handgrip strength (HGS/W) criteria, had the highest hazard ratio (HR, 2.07; 95%CI, 1.50-2.86) compared with other methods used to evaluate RMM. The GLIM criteria diagnosed malnutrition in 24% of cases (292 patients, using the CC and HGS/W criteria) and were effective for determining the nutrition status of LC patients. GLIM-diagnosed malnutrition was an independent risk factor for survival, and malnutrition severity was monotonically associated with death hazards (P = .002). The GLIM nomogram showed good performance in predicting the survival of LC patients, and the decision-curve analysis demonstrated that the nomogram was clinically useful. CONCLUSION: These findings support the effectiveness of GLIM in diagnosing malnutrition and predicting survival among LC patients.
Authors: Kea Turner; Naomi C Brownstein; Zachary Thompson; Issam El Naqa; Yi Luo; Heather S L Jim; Dana E Rollison; Rachel Howard; Desmond Zeng; Stephen A Rosenberg; Bradford Perez; Andreas Saltos; Laura B Oswald; Brian D Gonzalez; Jessica Y Islam; Amir Alishahi Tabriz; Wenbin Zhang; Thomas J Dilling Journal: Radiother Oncol Date: 2021-12-23 Impact factor: 6.280