Malnutrition predicts severe complications but not survival in laryngeal cancer surgery: a propensity-matched analysis

Guiren Fang, Ting Zhu, Zhenmeng Lin, Mingfang Yan, Lin Zh, Shaokun Weng, Cong Bian

Background The impact of preoperative malnutrition on clinical outcomes in patients undergoing laryngeal cancer surgery remains incompletely defined. This study aimed to evaluate the association between malnutrition and postoperative complications, long-term prognosis, and other clinical outcomes, and to compare the predictive performance of the GLIM criteria versus the ESPEN 2015 criteria. Methods A retrospective analysis was conducted on prospectively maintained records of 294 laryngeal cancer patients who underwent surgical resection. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria, and the ESPEN 2015 criteria were additionally applied for comparison. The cohort was chronologically divided into a training set ( n = 191) and a validation set ( n = 103). Independent risk factors for severe postoperative complications (POCs) were identified using LASSO regression followed by multivariate logistic regression, and a nomogram was constructed and validated. Cox regression analysis was performed to evaluate associations with overall survival. Propensity score matching (PSM) was applied to balance baseline characteristics between the GLIM-malnutrition group and the normal nutrition group, followed by comparative and subgroup analyses. Results The prevalence of preoperative malnutrition was 25.9% (76/294) according to GLIM criteria and 13.6% (40/294) according to ESPEN criteria. Malnutrition defined by both criteria was an independent risk factor for severe POCs, and the GLIM criteria demonstrated superior predictive performance. Age >65 years, diabetes, GLIM-malnutrition, and neck dissection were identified as independent risk factors for severe complications. The nomogram constructed based on these predictors exhibited robust predictive performance, with AUC values of 0.803 in the training set and 0.812 in the validation set, along with good calibration and net clinical benefit. In terms of prognosis, the 5-year overall survival rates were 55.0% in the GLIM-malnutrition group and 60.8% in the normal nutrition group, with no significant difference ( p = 0.077); malnutrition was not an independent prognostic factor. After PSM, the GLIM-malnutrition group showed a significantly higher incidence of severe POCs and a longer postoperative length of stay (PLOS). Subgroup analyses consistently demonstrated more severe POCs and longer PLOS in the GLIM-malnutrition group across all strata, with a greater number of total POCs observed in elderly patients. Conclusion Preoperative malnutrition diagnosed by GLIM criteria is highly prevalent in patients undergoing laryngeal cancer surgery and significantly increases the risk of severe complications and prolongs hospital stay. Compared with ESPEN criteria, GLIM criteria show stronger predictive performance for severe postoperative complications. However, preoperative malnutrition does not independently affect long-term overall survival.