• Liangyu Yin, Ling Zhang, Na Li, Jing Guo, Lijuan Liu, Xin Lin, Yang Fan, Jie Liu, Mengyuan Zhang, Feifei Chong, Xiao Chen, Chang Wang, Xu Wang, Tingting Liang, Xiangliang Liu, Li Deng, Wei Li, Mei Yang, Jiami Yu, Xiaojie Wang, Xing Liu, Shoumei Yang, Zheng Zuo, Kaitao Yuan, Miao Yu, Chunhua Song, Jiuwei Cui, Suyi Li, Zengqing Guo, Hanping Shi, Hongxia Xu, and Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) Group.
• Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
• Nutrition. 2021 Oct 1; 90: 111258.

ObjectivesHandgrip strength (HGS) is related to cancer mortality. The aim of this study was to compare the performance of the Asian Working Group for Sarcopenia 2019 (AWGS)- and optimal stratification (OS)-defined HGS thresholds for predicting the survival of patients with lung cancer (LC).MethodsWe performed an observational cohort study including 3230 patients with LC admitted to five institutions in China from November 2011 to January 2019. Comprehensive baseline and follow-up information was documented. Sex-specific thresholds for identifying patients with a low HGS were defined based on the AWGS (<28 kg in men and <18 kg in women) and the OS. The associations of a low HGS with survival were estimated by calculating multivariable-adjusted hazard ratios (HRs), and the relationships were flexibly modeled using restricted cubic splines.ResultsThe study included 1041 women and 2189 men with a mean age of 60 y and a median follow-up time of 761 d. The OS-calculated HGS thresholds were <31.2 kg in men and <22.4 kg in women. There were significant associations between a low HGS defined by the AWGS (n = 1392; 43.1%) or the OS (n = 2034; 63%) and various nutritional characteristics. An AWGS-defined low HGS was associated with prolonged hospitalization. The OS-defined low HGS group was associated with a 23% greater death hazard than the normal HGS group (HR, 1.23; 95% confidence interval, 1.08-1.40). An n-shaped non-linear association was observed between the HGS and survival in women (P = 0.003).ConclusionsThe OS-defined HGS thresholds show better performance than the AWGS for predicting the survival of patients with LC. Additionally, the HGS had n-shaped associations with the overall mortality among female patients with LC.Copyright © 2021 Elsevier Inc. All rights reserved.

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