# Combined Predictive Value of GLIM-Defined Malnutrition and Preoperative Adipose Tissue 18F-FDG Uptake for Recurrence-Free Survival After Radical Gastrectomy in Patients with Gastric Cancer

## TL;DR

Combining malnutrition assessment with preoperative fat tissue imaging improves prediction of cancer recurrence after surgery.

## Contribution

Integrating GLIM malnutrition criteria with adipose tissue 18F-FDG uptake enhances recurrence-free survival prediction in gastric cancer.

## Key findings

- GLIM-defined malnutrition and high VAT SUVmean are independent risk factors for recurrence-free survival.
- Patients with both malnutrition and high VAT SUVmean had the worst recurrence-free survival outcomes.
- The combined model outperformed GLIM criteria alone in predicting recurrence risk.

## Abstract

Predicting the risk of postoperative recurrence in patients with gastric cancer is highly valuable for facilitating diagnostic and treatment decisions. The Global Leadership Initiative on Malnutrition criteria provide a standardized approach for assessing the nutritional status of patients and demonstrate strong predictive value for the prognosis of patients with gastric cancer. However, these criteria do not incorporate indicators of adipose tissue metabolic activity, which may reflect pro-tumor microenvironmental factors. Recent studies have increasingly demonstrated associations between 18F-fluorodeoxyglucose uptake in the adipose tissue and the clinical staging or prognosis of various malignancies. This study demonstrated that combining malnutrition defined by the GLIM criteria with preoperative visceral adipose tissue 18F-fluorodeoxyglucose uptake optimizes the recurrence risk stratification and exhibits superior prognostic predictive efficacy compared to using the GLIM criteria alone. This approach provides new insights into individualized prognostic assessment and intervention strategies.

Background: The Global Leadership Initiative on Malnutrition (GLIM) criteria provide a standardized approach for assessing the nutritional status of patients and demonstrate strong predictive value for the prognosis of patients with gastric cancer. However, these criteria do not incorporate indicators of adipose tissue metabolic activity, which may reflect pro-tumor microenvironmental factors. This study investigated the combined predictive value of malnutrition, defined by the GLIM criteria, and preoperative adipose tissue 18F-fluorodeoxyglucose (18F-FDG) uptake for recurrence-free survival (RFS) in patients with gastric cancer following radical surgery. Methods: A total of 105 patients were retrospectively enrolled and classified into malnourished and non-malnourished groups based on the GLIM criteria. Preoperative 18F-FDG positron emission tomography/computed tomography (18F-FDG PET/CT) was used to measure the mean standardized uptake value (SUVmean) of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). The predictive values of these indicators for RFS in patients with gastric cancer were assessed. Results: Multivariate survival analysis was used to identify GLIM-defined malnutrition (p = 0.020) and increased preoperative VAT SUVmean (p = 0.042) as independent risk factors for RFS. The combined analysis revealed that patients with both malnutrition and a high preoperative VAT SUVmean had the poorest RFS (HR = 18.41, p < 0.001). The predictive model integrating GLIM criteria and VAT SUVmean outperformed the GLIM criteria alone. Conclusions: This study demonstrated that combining malnutrition defined by the GLIM criteria with preoperative visceral adipose tissue 18F-FDG uptake optimizes recurrence risk stratification and exhibits superior prognostic predictive efficacy compared to using the GLIM criteria alone. This approach provides new insights into individualized prognostic assessment and intervention strategies.