ESPEN 2020 Abstract Submission

Topic: Nutrition and cancer

Abstract Submission Identifier: ESPEN20-ABS-1099

THE GLIM CRITERIA AS AN EFFECTIVE TOOL FOR NUTRITION ASSESSMENT AND SURVIVAL PREDICTION IN ELDERLY CANCER PATIENTS

X. Zhang^*, ^{1, 2, 3}, M. Tang ^{1, 2, 3}, Q. Zhang ^{1, 2, 3}, K. Zhang ^{1, 2, 3}, Z. Guo ⁴, H. Xu ⁵, K. Yuan ⁶, M. Yu ⁶, M. Braga ⁷, T. Cederholm ⁸, W. Li ⁹, R. Barazzoni ¹⁰, H. Shi ^{1, 2, 3}

¹Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, ²Department of Oncology, Capital Medical University, ³Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, ⁴Department of Medical Oncology, Fujian Cancer Hospital, Fu zhou, ⁵Department of Clinical Nutrition, Daping Hospital, Third Military Medical University, Chongqing, ⁶Department of Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China, ⁷Department of Surgery, San Raffaele Hospital, Via Olgettina, Milan, Italy, ⁸Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden, ⁹Cancer Center of the First Hospital of Jilin University, Changchun, China, ¹⁰Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

Rationale: The Global Leadership Initiative on Malnutrition (GLIM) released new criteria for diagnosing and grading malnutrition, but its validation in diverse populations is not well documented. We herein investigated using the GLIM criteria in elderly cancer patients.

Methods: This retrospective cohort analysis was conducted on a primary cohort of 1192 cancer patients aged 65 years or older enrolled from a multi-institutional registry, and a validation cohort of 300 elderly cancer patients treated at the First Affiliated Hospital of Sun Yat-sen University. Patients considered at-risk for malnutrition based on the NRS-2002 were assessed using the GLIM criteria. The association between the nutritional status and patients’ overall survival (OS) was then analyzed by the Kaplan-Meier method and a Cox model. A nomogram was also established that included additional independent clinical prognostic variables. To determine the predictive accuracy and discriminatory capacity of the nomogram, the C-index, receiver operating characteristic (ROC) curve and calibration curve were evaluated.

Results: The percentage of patients considered “at-risk” for malnutrition was 64.8% and 67.3% for the primary and validation cohorts, respectively. GLIM-defined malnutrition was diagnosed in 48.4% of patients in the primary cohort and 46.0% in the validation cohort, with similar proportions of moderate and severe malnutrition in both cohorts. In the primary cohort, patients at risk of malnutrition (NRS-2002 ≥3) showed a worse OS than those with a NRS-2002<3 (HR 1.34, 1.10-1.64; p=0.003). Additionally, patients with GLIM-defined severe malnutrition (HR1.71, 1.37-2.14; p<0.001) or moderate malnutrition (HR1.35, 1.09-1.66; p=0.006) showed a significantly shorter OS compared to those without malnutrition. Furthermore, patients with severe malnutrition showed a trend towards a lower OS than those with moderate malnutrition (HR1.27,1.00-1.61; p=0.052).The nomogram incorporating the domains of the GLIM with other variables was accurate, especially for predicting the 1- and 2-year overall survival rates.

Conclusion: The GLIM criteria can be used in elderly cancer patients not only to assess malnutrition, but also to discriminate the survival outcome. The nomogram developed based on the GLIM domains can provide a more accurate prediction of the prognosis than existing systems.

Disclosure of Interest: None Declared

Keywords: elderly cancer patients, GLIM criteria