Different Muscle Mass Indices of GLIM in Diagnosing Malnutrition and Predicting Survival of Patients with Gastric Cancer

ABSTRACT Objective Malnutrition is common and related to negative prognosis in patients with gastric cancer (GC). The Global Leadership Initiative on Malnutrition (GLIM), a novel consensus for the diagnosis of malnutrition, was proposed recently. However, the roles of GLIM in diagnosing malnutrition and predicting overall survival (OS) in patients with GC have been unclear. Method We conducted a multicenter, observational cohort study including 877 hospitalized patients with GC from 2013 to 2018. Different anthropometric measurements were compared to assess reduced muscle mass (RMM). Kaplan-Meier curves and multivariate Cox regression were performed to analyze the relationship between GLIM-defined malnutrition and the OS of patients with GC. Independent prognostic variables were incorporated to develop a nomogram for individualized survival prediction. The calibration curve was used to determine the predictive accuracy and discriminatory capacity of the nomogram. In addition, 219 patients with GC were enrolled for external validation. Result A total of 464 (53%) patients with GC were diagnosed with malnutrition. Patients diagnosed with severe malnutrition using either mid-arm circumference (MAC) or body weight-standardized hand grip strength (HGS/W) positive method had a shorter median survival time (16.7 months, IQR [8.4-32.7]) and higher hazard ratio (HR = 1.49, 1.15-1.92, P = 0.002). Severe malnutrition was an independent risk factor for OS (HR = 1.32, 1.02-1.71, P = 0.038). The GLIM nomogram showed good performance in predicting the 3-year survival in patients with GC. Conclusion Our findings support the effectiveness of GLIM in diagnosing malnutrition and predicting the OS in patients with GC.