Background: There are several approaches that can be used for the pre-treatment identification of
malnutrition in oncology populations including the Patient-Generated Subjective Global Assessment (PG-SGA), the 2015 consensus statement by the European Society for Clinical Nutrition and Metabolism (ESPEN 2015) and the Global Leadership Initiative on
Malnutrition (GLIM). Aims: This study aimed to evaluate whether
malnutrition, as defined by these three methods, can be used to predict complications in
esophageal cancer (EC) patients after
esophagectomy. Methods: We performed a single center, observational cohort study that included 360 EC patients undergoing
esophagectomy from December 2014 to November 2019 at Daping Hospital in China. The prevalence of
malnutrition in the study population was prospectively defined using the PG-SGA (≥9 defined
malnutrition), and retrospectively defined using the ESPEN 2015 and the GLIM. The prevalence of
malnutrition and association with postoperative complications were compared in parallel for the three methods. Results: The prevalence of
malnutrition before surgery was 23.1% (83/360), 12.2% (44/360), and 33.3% (120/360) in the study population, as determined by the PG-SGA, the ESPEN 2015 and the GLIM, respectively. The PG-SGA and GLIM had higher diagnostic concordance (Kappa = 0.519, P < 0.001) compared to the ESPEN 2015 vs. GLIM (Kappa = 0.361, P < 0.001) and PG-SGA vs. ESPEN 2015 (Kappa = 0.297, P < 0.001). The overall incidence of postoperative complications for the study population was 58.1% (209/360). GLIM- and ESPEN 2015-defined
malnutrition were both associated with the total number of postoperative complications in multivariable analyses. Moreover, GLIM-defined
malnutrition exhibited the highest power to identify the incidence of complications among all independent predictors in a pooled analysis. Conclusion: Among the PG-SGA, the ESPEN 2015 and the GLIM, the GLIM framework defines the highest prevalence rate of
malnutrition and appears to be the optimal method for predicting postoperative complications in EC patients undergoing
esophagectomy. These results support the importance of preoperatively identifying
malnutrition using appropriate assessment tools, because it can facilitate the selection of management strategies that will optimize the clinical outcomes of EC patients.