ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
The role of L3 skeletal muscle index in the diagnosis and prognosis prediction of sarcopenia and malnutrition in cancer patients
Zhuo Chen 1
Deduo Xu 2
Xingyun Hou 2
Zhipeng Wang 2
Jinping Xiong 2
Mingying Geng 2
Jing Xu 2
Yanyan Gu 2
1. Daping Hospital, Chongqing, China
2. Shanghai Changzheng Hospital, Shanghai, China
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Abstract
Objective: This study investigated the validity of the third lumbar skeletal muscle index (L3-SMI) as a marker of reduced muscle mass (RMM) in hospitalized cancer patients. It further evaluated the diagnostic accuracy of L3-SMI for malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and examined the relationship between L3-SMI and long-term survival in cancer patients. Methods: A retrospective analysis was conducted between April 2014 and November 2018 at Daping Hospital, affiliated with Army Medical University. A total of 284 cancer patients were included. Analytical methods used in this study comprised receiver operating characteristic (ROC) curve analysis, Kaplan-Meier survival analysis, Cox proportional hazards regression models, time-dependent ROC curves, and kappa statistics. Results: Using the GLIM criteria with L3-SMI, 99 patients (34.86%) were diagnosed with malnutrition. Cox regression analysis revealed that patients diagnosed with malnutrition based on L3-SMI had the highest hazard ratio (HR = 1.954, 95% CI = 1.291-2.958) for mortality. Kaplan-Meier survival analysis showed that malnourished patients had significantly poorer overall survival. The agreement between GLIM-SMI and the Patient-Generated Subjective Global Assessment (PG-SGA) in diagnosing malnutrition was moderate (Kappa = 0.550). Time-dependent ROC curve analysis demonstrated that the area under the curve (AUC) for GLIM-SMI was 0.617, 0.578, and 0.578 at 1-year, 3-year, and 5-year survival monitoring, respectively. Conclusion: The L3-SMI may be a useful alternative indicator for reduced muscle mass in hospitalized cancer patients. GLIM evaluated by incorporation of L3-SMI is independently associated with long-term survival outcomes in this patient population. The prognostic significance of GLIM-L3-SMI requires further validation in other cohorts with large sample size.
Summary
Keywords
Cancer, Global Leadership Initiative on Malnutrition criteria, Malnutrition, reduced muscle mass, Skeletal muscle index
Received
03 December 2025
Accepted
16 February 2026
Copyright
© 2026 Chen, Xu, Hou, Wang, Xiong, Geng, Xu and Gu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Zhuo Chen
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