GLIM Criteria as Prognostic Factor in Patients Undergoing Adjuvant S‐1 Chemotherapy for Biliary Tract Cancer

Biliary tract cancers (BTCs) have poor prognoses, with limited curative options beyond surgical resection. Adjuvant S-1 chemotherapy has shown survival benefits in Japanese patients undergoing resection for BTC. However, prognostic factors influencing survival in these patients remain uncertain. In this study, we aimed to investigate the efficacy of preoperative nutritional status using the Global Leadership Initiative on Malnutrition (GLIM) criteria as a prognostic factor in patients receiving adjuvant S-1 chemotherapy for BTC. In this retrospective study, excluding intrahepatic cholangiocarcinoma, we evaluated 58 patients who underwent curative surgery for BTC at Kobe University from 2013 to 2022, followed by adjuvant S-1 chemotherapy. Nutritional status was classified by GLIM criteria into normal/moderate and severe malnutrition groups. Overall (OS) and recurrence-free (RFS) survival were analyzed using Kaplan-Meier and Cox proportional hazards models. Of the 58 patients, 3.4% had no malnutrition, 72.5% had moderate malnutrition, and 24.1% had severe malnutrition. Patients with severe malnutrition had significantly worse 5-year OS (24.7% vs. 52.5%, p=0.0014) and RFS (34.3% vs. 52.0%, p=0.0066). Severe malnutrition was an independent prognostic factor for poorer OS (hazard ratio=3.40, 95% confidence interval=1.46-7.94; p=0.0047) and RFS (hazard ratio=2.48, 95% confidence interval=1.07-5.76; p=0.035). No significant difference in S-1 completion rates was observed. Severe malnutrition, as defined by GLIM criteria, is a poor prognostic factor in patients with BTCs undergoing adjuvant S-1 chemotherapy.