Abstract
Background: The Global Leadership Initiative on Malnutrition (GLIM) criteria provides a framework for
assessing cachexia in cancer patients. However, the role of systemic inflammation in this framework
needs further exploration.
Methods: This study analyzed a cohort of 388 advanced cancer patients from 18 oncological care settings.
C-reactive protein (CRP), the modified Glasgow Prognostic Score (mGPS) and Neutrophil-to-Lymphocyte
Ratio (NLR) were used to assess systemic inflammation. Associations between these inflammatory
markers and Weight Loss (WL), Body Mass Index (BMI), Skeletal Muscle Index (SMI), and survival outcomes (OS) were evaluated using Chi-square and KaplaneMeier survival analyses.
Results: CRP was significantly associated with ECOG-PS (p < 0.01), and WL (p < 0.05). mGPS was
significantly associated with ECOG-PS (p < 0.001), WL (p < 0.001), and BMI (p < 0.05). NLR was
significantly associated with ECOG-PS (p < 0.05), WL (p < 0.001), and BMI (p < 0.05). CRP (p < 0.001),
mGPS (p < 0.001), NLR (p < 0.001), WL (p < 0.001), and SMI (p < 0.05) were significantly associated with
OS, but not BMI (p ¼ 0.23). Combining CRP, mGPS, NLR, with WL, BMI, and SMI significantly improved OS
prediction. WL was significantly associated with OS in patients with NLR<3 (p < 0.05) but not in
CRP10 mg/L or mGPS ¼ 0. SMI was significantly associated with OS in patients with mGPS ¼ 0
(p < 0.05).
Conclusion: Systemic inflammation, as assessed by CRP, mGPS and NLR, significantly improves the
relationship between phenotypic criteria and OS. These findings support the GLIM framework's inclusion
of systemic inflammation as a critical factor. Given its strong predictive value, systemic inflammation
should be prioritized in routine clinical assessments of cancer patients, with mGPS having greater
prognostic value within the GLIM framework
assessing cachexia in cancer patients. However, the role of systemic inflammation in this framework
needs further exploration.
Methods: This study analyzed a cohort of 388 advanced cancer patients from 18 oncological care settings.
C-reactive protein (CRP), the modified Glasgow Prognostic Score (mGPS) and Neutrophil-to-Lymphocyte
Ratio (NLR) were used to assess systemic inflammation. Associations between these inflammatory
markers and Weight Loss (WL), Body Mass Index (BMI), Skeletal Muscle Index (SMI), and survival outcomes (OS) were evaluated using Chi-square and KaplaneMeier survival analyses.
Results: CRP was significantly associated with ECOG-PS (p < 0.01), and WL (p < 0.05). mGPS was
significantly associated with ECOG-PS (p < 0.001), WL (p < 0.001), and BMI (p < 0.05). NLR was
significantly associated with ECOG-PS (p < 0.05), WL (p < 0.001), and BMI (p < 0.05). CRP (p < 0.001),
mGPS (p < 0.001), NLR (p < 0.001), WL (p < 0.001), and SMI (p < 0.05) were significantly associated with
OS, but not BMI (p ¼ 0.23). Combining CRP, mGPS, NLR, with WL, BMI, and SMI significantly improved OS
prediction. WL was significantly associated with OS in patients with NLR<3 (p < 0.05) but not in
CRP10 mg/L or mGPS ¼ 0. SMI was significantly associated with OS in patients with mGPS ¼ 0
(p < 0.05).
Conclusion: Systemic inflammation, as assessed by CRP, mGPS and NLR, significantly improves the
relationship between phenotypic criteria and OS. These findings support the GLIM framework's inclusion
of systemic inflammation as a critical factor. Given its strong predictive value, systemic inflammation
should be prioritized in routine clinical assessments of cancer patients, with mGPS having greater
prognostic value within the GLIM framework
| Original language | English |
|---|---|
| Journal | Clinical nutrition ESPEN |
| Early online date | 24 Mar 2025 |
| Publication status | Published - 1 Jun 2025 |