Valor prognóstico das diferentes combinações dos critérios GLIM em pacientes com câncer colorretal

Abstract

Colorectal cancer (CRC) represents one of the major public health challenges, with high incidence and mortality rates. Malnutrition is a common condition in these patients, associated with poorer treatment response and reduced survival. The Global Leadership Initiative on Malnutrition (GLIM) criteria have been proposed as a tool for diagnosing malnutrition; however, their prognostic validity has not yet been widely explored in CRC patients. The aim of the present study was to evaluate the prognostic value of different combinations of GLIM criteria on the overall survival of CRC patients. This is an observational, longitudinal, and prospective study involving 89 CRC patients treated at Hospital do Câncer I of INCA. Nutritional status was assessed using the GLIM criteria, considering the phenotypic criteria: weight loss ≥5% in 6 months, low body mass index (BMI <20 kg/m² for patients under 70 years old or <22 kg/m² for those aged 70 and above), and reduced muscle mass. Muscle mass was assessed using computed tomography (CT) at the level of the third lumbar vertebra (L3), with cutoff points for the skeletal muscle index of <52 cm²/m² for men and <38 cm²/m² for women (BMI <30 kg/m²) and <54 cm²/m² for men and <47 cm²/m² for women (BMI ≥30 kg/m²). When CT was not available, bioelectrical impedance analysis (BIA) was used, with cutoff points for the skeletal muscle index of ≤10.75 kg/m² for men and ≤6.75 kg/m² for women. The etiological criteria included reduced food intake (assessed by the Patient-Generated Subjective Global Assessment - PG-SGA) and the presence of inflammation, defined by advanced cancer staging (III-IV) or a neutrophil-to-lymphocyte ratio (NLR) >3. Overall survival was analyzed using the Kaplan-Meier method and Cox regression models. Among the 89 patients, 76% were at nutritional risk. The prevalence of malnutrition ranged from 7% to 59%, depending on the combination of GLIM criteria. The combination of weight loss and inflammation had the highest mortality rate (50%), followed by the combination of reduced muscle mass and inflammation (43%). Multivariate analysis revealed that the combination of reduced muscle mass and inflammation was an independent predictor of decreased two-year survival (HR=4.08; 95% CI: 1.42–11.68; p=0.009). Additionally, advanced disease staging (stage IV) was also significantly associated with lower survival (p<0.05). These findings highlight the importance of assessing the distinct forms of malnutrition defined by the GLIM criteria and emphasize the need to employ specific and appropriate techniques for muscle mass measurement.