Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Communication
  • Published:

Prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer

European Journal of Clinical Nutrition volume 59, pages 35–40 (2005)Cite this article

Abstract

Objective: To evaluate the prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer and create statistically distinct prognostic groups of colorectal cancer patients based on clinical and nutritional variables.

Design: A retrospective clinical epidemiologic study.

Setting: A private tertiary care American Cancer Center.

Subjects: In total, 234 colorectal cancer patients aged 29–82 y treated at Cancer Treatment Centers of America at Midwestern Regional Medical Center between January 1995 and March 2001.

Intervention: SGA Questionnaire. SGA A—well nourished; SGA B—moderately malnourished; and SGA C—severely malnourished. Malnutrition was defined as either SGA B or SGA C.

Results: The prevalence of malnutrition in this patient population, as determined by SGA, was 52% (113/217). The median survival of patients with SGA A was 12.8 months (95% CI; 9.1–16.5), those with SGA B was 8.8 months (95% CI; 6.7–10.9) and those with SGA C was 6 months (95% CI; 3.9–8.1); the difference being statistically significant at P=0.0013. Regression tree analysis identified prior treatment history, lactate dehydrogenase (LDH) and SGA to be important predictors of survival for our patient cohort. Patients with no prior treatment history (newly diagnosed disease), low LDH scores, and SGA A had the best overall survival of 40.4 months (95% CI; 30.45–50.4), whereas patients with prior treatment history (progressive disease), high LDH scores, and SGA B/C had the worst overall survival of 4.5 months (95% CI; 2.22–6.76).

Conclusion: The SGA provides useful prognostic information in patients with advanced colorectal cancer.

Sponsors: Cancer Treatment Centers of America.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  • Bauer J, Capra S & Ferguson M (2002): Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur. J. Clin. Nutr. 56, 779–785.

    Article  CAS  Google Scholar 

  • Carney DE & Meguid MM (2002): Current concepts in nutritional assessment. Arch. Surg. 137, 42–45.

    Article  Google Scholar 

  • Chang AE, Steinberg SM, Culnane M & White DE (1989): Determinants of survival in patients with unresectable colorectal liver metastases. J. Surg. Oncol. 40, 245–251.

    Article  CAS  Google Scholar 

  • D'Eredita G, Serio G, Neri V, Polizzi RA, Barberio G & Losacco T (1996): A survival regression analysis of prognostic factors in colorectal cancer. Aust. N. Z. J. Surg. 66, 445–451.

    Article  CAS  Google Scholar 

  • Detsky AS, Baker JP, Mendelson RA, Wolman SL, Wesson DE & Jeejeebhoy KN (1984): Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons. J. Parenter. Enteral. Nutr. 8, 153–159.

    Article  CAS  Google Scholar 

  • Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA & Jeejeebhoy KN (1987): What is subjective global assessment of nutritional status? J. Parenter. Enteral. Nutr. 11, 8–13.

    Article  CAS  Google Scholar 

  • Duerksen DR, Yeo TA, Siemens JL & O'Connor MP (2000): The validity and reproducibility of clinical assessment of nutritional status in the elderly. Nutrition 16, 740–744.

    Article  CAS  Google Scholar 

  • Ek AC, Unosson M, Larsson J, Ganowiak W & Bjurulf P (1996): Interrater variability and validity in subjective nutritional assessment of elderly patients. Scand. J. Caring. Sci. 10, 163–168.

    Article  CAS  Google Scholar 

  • Enia G, Sicuso C, Alati G & Zoccali C (1993): Subjective Global Assessment of nutrition in dialysis patients. Nephrol. Dial. Transplant. 8, 1094–1098.

    CAS  Google Scholar 

  • Ferguson ML, Bauer J, Gallagher B, Capra S, Christie DR & Mason BR (1999a): Validation of a malnutrition screening tool for patients receiving radiotherapy. Australas. Radiol. 43, 325–327.

    Article  CAS  Google Scholar 

  • Ferguson M, Capra S, Bauer J & Banks M (1999b): Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition 15, 458–464.

    Article  CAS  Google Scholar 

  • Fountzilas G, Gossios K, Zisiadis A, Svarna E, Skarlos D & Pavlidis N (1996): Prognostic variable in patients with advanced colorectal cancer treated with fluorouracil and leucovorin-based chemotherapy. Med. Pediatr. Oncol. 26, 305–317.

    Article  CAS  Google Scholar 

  • Green S, Benedetti J & Crowley J (2003): Interdisciplinary Statistics: Clinical Trials in Oncology pp 219–224. London/Boca Raton, FL: Chapman & Hall/CRC.

    Google Scholar 

  • Hasse J, Strong S, Gorman MA & Liepa G (1993): Subjective global assessment: alternative nutrition-assessment technique for liver-transplant candidates. Nutrition 9, 339–343.

    CAS  Google Scholar 

  • Hawk ET, Limburg PJ & Viner JL (2002): Epidemiology and prevention of colorectal cancer. Surg. Clin. North Am. 82, 905–941.

    Article  Google Scholar 

  • Heys SD, Walker LG, Deehan DJ & Eremin OE (1998): Serum albumin: a prognostic indicator in patients with colorectal cancer. J. R. Coll. Surg. Edinb. 43, 163–168.

    CAS  PubMed  Google Scholar 

  • Hirsch S, de Obaldia N, Petermann M, Rojo P, Barrientos C, Iturriaga H & Bunout D (1991): Subjective global assessment of nutritional status: further validation. Nutrition 7, 35–37. discussion 37–38.

    CAS  PubMed  Google Scholar 

  • Jones CH, Newstead CG, Will EJ, Smye SW & Davison AM (1997): Assessment of nutritional status in CAPD patients: serum albumin is not a useful measure. Nephrol. Dial. Transplant. 12, 1406–1413.

    Article  CAS  Google Scholar 

  • Kemeny N & Braun Jr DW (1983): Prognostic factors in advanced colorectal carcinoma. Importance of lactic dehydrogenase level, performance status, and white blood cell count. Am. J. Med. 74, 786–794.

    CAS  PubMed  Google Scholar 

  • Kemeny N, Niedzwiecki D, Shurgot B & Oderman P (1989): Prognostic variables in patients with hepatic metastases from colorectal cancer. Importance of medical assessment of liver involvement. Cancer 63, 742–747.

    Article  CAS  Google Scholar 

  • Kouri M, Pyrhonen S & Kuusela P (1992): Elevated CA19-9 as the most significant prognostic factor in advanced colorectal carcinoma. J. Surg. Oncol. 49, 78–85.

    Article  CAS  Google Scholar 

  • Lindmark G, Gerdin B, Pahlman L, Bergstrom R & Glimelius B (1994): Prognostic predictors in colorectal cancer. Dis. Colon. Rectum 37, 1219–1227.

    Article  CAS  Google Scholar 

  • Ottery FD (1994): Rethinking nutritional support of the cancer patient: the new field of nutritional oncology. Semin. Oncol. 21, 770–778.

    CAS  PubMed  Google Scholar 

  • Ottery FD (1996): Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition 12, S15–S19.

    Article  CAS  Google Scholar 

  • Persson C, Sjoden PO & Glimelius B (1999): The Swedish version of the patient-generated subjective global assessment of nutritional status: gastrointestinal vs urological cancers. Clin. Nutr. 18, 71–77.

    Article  CAS  Google Scholar 

  • Sacks GS, Dearman K, Replogle WH, Cora VL, Meeks M & Canada T (2000): Use of subjective global assessment to identify nutrition-associated complications and death in geriatric long-term care facility residents. J. Am. Coll. Nutr. 19, 570–577.

    Article  CAS  Google Scholar 

  • Steinberg J, Erlichman C, Gadalla T, Fine S & Wong A (1992): Prognostic factors in patients with metastatic colorectal cancer receiving 5-fluorouracil and folinic acid. Eur. J. Cancer 28A, 1817–1820.

    Article  CAS  Google Scholar 

  • Thoresen L, Fjeldstad I, Krogstad K, Kaasa S & Falkmer UG (2002): Nutritional status of patients with advanced cancer: the value of using the subjective global assessment of nutritional status as a screening tool. Palliat. Med. 16, 33–42.

    Article  Google Scholar 

  • Waitzberg DL & Correia MI (2003): Nutritional assessment in the hospitalized patient. Curr. Opin. Clin. Nutr. Metab. Care 6, 531–538.

    Article  Google Scholar 

  • Wang WS, Lin JK, Chiou TJ, Liu JH, Fan FS, Yen CC, Lin TC, Jiang JK, Yang SH, Wang HS & Chen PM (2002): CA19-9 as the most significant prognostic indicator of metastatic colorectal cancer. Hepatogastroenterology 49, 160–164.

    PubMed  Google Scholar 

  • Yuste AL, Aparicio J, Segura A, Lopez-Tendero P, Girones R, Perez-Fidalgo JA, Diaz R & Calderero V (2003): Analysis of clinical prognostic factors for survival and time to progression in patients with metastatic colorectal cancer treated with 5-fluorouracil-based chemotherapy. Clin. Colorectal Cancer 2, 231–234.

    Article  Google Scholar 

Download references

Acknowledgements

This study was funded by Cancer Treatment Centers of America.

Author information

Authors and Affiliations

  1. Cancer Treatment Centers of America® at Midwestern Regional Medical Center, Zion, IL, USA

    D Gupta, C A Lammersfeld, P G Vashi, J Burrows, C G Lis & J F Grutsch

Authors
  1. D Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C A Lammersfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P G Vashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Burrows
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C G Lis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J F Grutsch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D Gupta.

Additional information

Guarantor: D Gupta.

Contributors: DG was the main author of the manuscript, initiated the study, collected, analyzed and interpreted data. PGV supervised the project and assisted in interpretation of results. CAL and JB assisted in writing the manuscript. CGL initiated the study and assisted in writing and interpretation. JFG supervised the project and assisted with the statistical analysis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gupta, D., Lammersfeld, C., Vashi, P. et al. Prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer. Eur J Clin Nutr 59, 35–40 (2005). https://doi.org/10.1038/sj.ejcn.1602029

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602029

Keywords

This article is cited by

Search

Advanced search

Quick links