背景:新发布的亚洲恶病质工作组(AWGC)标准与全球营养不良领导力倡议(GLIM)标准具有相似的诊断项目。这项研究旨在比较胃癌患者的AWGC恶病质和GLIM营养不良,并研究一种诊断是否继续成为诊断患有另一种疾病的个体的预后因素。
方法:前瞻性收集2013-2019年胃癌根治术患者资料。AWGC和GLIM标准用于诊断恶病质和营养不良,分别。采用单因素和多因素logistic及Cox回归验证相关因素对术后并发症及总生存期的影响。
结果:共纳入1420例患者,其中174例(12.3%)仅被诊断为AWGC恶病质,85(6.0%)仅被诊断为GLIM营养不良,324例(22.8%)患有AWGC恶病质和GLIM营养不良。AWGC恶病质和GLIM营养不良是并发症和总生存期的独立危险因素。当他们共存时,比值比(OR)和风险比(HR)趋于更高.在AWGC-恶病质子集中,校正混杂因素后,GLIM-营养不良仍是总生存的独立危险因素(HR=1.544,95%CI=1.098~2.171,P=0.012)。同样,在GLIM-营养不良子集中,AWGC恶病质仍是影响患者总生存的独立危险因素(HR=1.697,95%CI=1.087~2.650,P=0.020)。同时患有恶病质和营养不良的患者的总体生存率最差。
结论:AWGC-恶病质和GLIM-营养不良标准是反映术前营养评估死亡风险的两种非冗余工具。
BACKGROUND: The newly released Asian Working Group for
Cachexia (AWGC) criteria share similar diagnostic items with the Global Leadership Initiative on Malnutrition (GLIM) criteria. This study aims to compare the AWGC
cachexia and GLIM malnutrition in patients with gastric cancer and investigate whether one diagnosis continues to be a prognostic factor in individuals diagnosed with the other condition.
METHODS: Data of patients who underwent radical gastrectomy for gastric adenocarcinoma were prospectively collected from 2013 to 2019. The AWGC and GLIM criteria were applied to diagnosis
cachexia and malnutrition, respectively. Univariate and multivariate logistic and Cox regression were used to verify the effect of relevant factors on postoperative complications and overall survival.
RESULTS: A total of 1420 patients were included, among whom 174 (12.3 %) were diagnosed with AWGC-cachexia alone, 85 (6.0 %) were diagnosed with GLIM-malnutrition alone, and 324 (22.8 %) had both AWGC-cachexia and GLIM-malnutrition. Both AWGC-
cachexia and GLIM-malnutrition were independent risk factors for complications and overall survival. When they coexisted, the odds ratios (OR) and hazard ratios (HR) tended to be higher. In the AWGC-cachexia subset, GLIM-malnutrition remained an independent risk factor (HR = 1.544, 95 % CI = 1.098-2.171, P = 0.012) for overall survival after the adjustment of confounding factors. Similarly, in the GLIM-malnutrition subset, AWGC-cachexia remained an independent risk factor for overall survival (HR = 1.697, 95 % CI = 1.087-2.650, P = 0.020). Patients with both
cachexia and malnutrition had the worst overall survival.
CONCLUSIONS: AWGC-cachexia and GLIM-malnutrition criteria were two non-redundancy tools in reflecting mortality risk in preoperative nutritional assessment.