Effect of preoperative malnutrition using global leadership initiative on malnutrition (GLIM) criteria on short- and long-term outcomes of patients with pancreatic head cancer

Abstract

Background: Although malnutrition is a global concern, there has been a lack of consensus on diagnostic criteria for application in clinical settings. Therefore, the Global Leadership Initiative in Malnutrition (GLIM) criteria has recently developed for assessing the malnutrition. The aim of study is to assess the effect of preoperative malnutrition, by means of GLIM criteria for predicting short- and long-term outcomes in patients who underwent curative pancreatoduodenectomy (PD). Methods: From 2004 to 2018, 228 consecutive patients who underwent curative PD in our center for pancreatic ductal adenocarcinoma. The definition of malnutrition is based on both phenotypic criteria (weight loss, low body mass index [BMI] and reduced muscle mass), and etiologic criteria (reduced intake or assimilation and inflammation) in GLIM criteria. Results: 75 (32.9%) of 228 patients were classified as with malnutrition. Preoperative malnutrition associated with an increased risk of estimated blood loss (816.7±875.2 vs. 593.1±489.9, P=0.015) and total hospital stay (27.3±15.7 vs. 22.9±17.7, P=0.045). The mediam follow-up period was 9.5months. The malnourished patients had inferior median 1-/3-/5-year overall survival, when compared to well-nourished patients (66.3%, 18.0% and 12.0% vs. 81.3%, 51.8% and 39.3%, P< 0.001). On multivariate analysis, malnutrition (Hazard Ratio 1.81, P=0.002) correlated independently with poor survival. Conclusion: The GLIM criteria is a simple and useful tool for predicting the short- and long-term outcomes of pancreatic head cancer patients who underwent PD.