Work

Impact of PG-SGA-assessed malnutrition stratification on clinical outcomes in advanced gastrointestinal malignancies: a retrospective cohort study

Year: 2025

Type: article

Abstract: INTRODUCTION: The traditional TNM staging system fails to explain survival heterogeneity in advanced gastrointestinal cancer, while malnutrition remains an underutilized prognostic modulator. We aimed to establish the prognostic value of dynamic nutritional risk stratification using the Patient-Generated Subjective Global Assessment (PG-SGA). METHODS: In this retrospective cohort study, 102 patients with AJCC 8th edition stage II-IV gastrointestinal malignancies underwent serial PG-SGA assessments at admission and 3-month follow-up. Nutritional risk was stratified as low-risk (PG-SGA 3-8) or high-risk (PG-SGA ≥ 9). Associations with overall survival (OS) were analyzed via Kaplan-Meier curves and multivariable Cox regression. RESULTS: Among 102 advanced gastrointestinal malignancies patients, 68.63% (70/102) were high-risk nutritional group at admission versus 31.37% low-risk, with lower BMI in high-risk group (19.13 vs. 21.52 kg/m², P < 0.001) but comparable inflammatory/nutritional markers (P > 0.05). By 3 months, high-risk prevalence rose to 77.45% (79/102), where low-risk patients showed superior weight (58.00 vs. 50.00 kg), BMI (20.55 vs. 18.92 kg/m²), HB (120.13 vs. 100.91 g/L), ALB (41.15 vs. 34.33 g/L), PNI (47.12 vs. 39.72), CRP (1.63 vs. 11.54 mg/L), and dietary intake (all P < 0.05). Survival analysis confirmed 5-fold higher 3-year mortality risk in high-risk group (HR = 5.00, 95% CI: 2.00-12.47; P < 0.001). Multivariable analysis identified TNM stage IV (HR = 3.78, 95% CI: 1.25-11.42; P = 0.018), persistent high nutritional risk (HR = 4.09, 95% CI: 1.38-12.14; P = 0.011), and elevated CRP (HR = 2.32, 95% CI: 1.14-4.73; P = 0.020) as independent death predictors. CONCLUSION: Longitudinal PG-SGA monitoring identifies critical nutritional deterioration threshold of PG-SGA ≥ 9 at 3-month follow-up and enables early intervention. We advocate integrating dynamic nutritional risk assessment into clinical frameworks to shift from empirical to predictive management in gastrointestinal oncology.

Source: BMC Gastroenterology

DOI: 10.1186/s12876-025-04374-0