Abstract
Background: The geriatric nutritional risk index (GNRI) was developed to evaluate the prognosis in elderly hospitalized patients at risk of malnutrition and related morbidity and mortality. This study aimed to evaluate the relationship between preoperative GNRI and long-term outcomes in elderly gastric cancer patients.Materials and Methods: We retrospectively reviewed 297 consecutive patients aged ≥ 65 years who underwent laparoscopic gastrectomy with R0 resection and evaluated their overall survival (OS) and cancer-specific survival (CSS).Results: In the univariate analyses, OS was significantly associated with the American Society of Anesthesiologists Physical Status (ASA-PS), tumor size, tumor differentiation, pathological stage, carcinoembryonic antigen (CEA), C-reactive protein, postoperative complications, and GNRI, whereas in the univariate analyses of CSS, ASA-PS, tumor size, tumor differentiation, pathological stage, CEA, postoperative adjuvant chemotherapy, and GNRI were significantly associated with poor prognosis. In the multivariate analysis, ASA-PS, tumor differentiation, pathological stage, and GNRI were significant independent prognostic factors of OS, whereas ASA-PS, pathological stage, and CEA were significant independent prognostic factors of CSS.Conclusions: GNRI is significantly associated with OS and CSS in elderly gastric cancer patients and is an independent predictor of OS. It is a simple, cost-effective, and promising nutritional index for predicting OS in elderly patients.
Highlights
The tumor–node–metastasis (TNM) staging has been the global standard for estimating cancer cell dissemination [1]
There was a significant association between the geriatric nutritional risk index (GNRI) and clinicopathological factors such as age (p < 0.001), body mass index (BMI) (p < 0.001), American Society of Anesthesiologists physical status (ASA-PS) (p = 0.014), red blood cell (RBC) count (p < 0.001), albumin (p < 0.001), C-reactive protein (CRP) (p < 0.001), tumor size (p < 0.001), tumor differentiation (p = 0.021), depth of tumor (p < 0.001), pathological stage (p < 0.001), and intraoperative blood loss (p = 0.048)
GNRI values were significantly associated with age (p < 0.001), BMI (p < 0.001), RBC (p < 0.001), albumin (p < 0.001), CRP (p < 0.001), tumor size (p < 0.001), operative procedure (p = 0.043), depth of tumor (p < 0.001), pathological stage (p < 0.001), and intraoperative blood loss (p = 0.029)
Summary
The tumor–node–metastasis (TNM) staging has been the global standard for estimating cancer cell dissemination [1]. The impact of the nutritional status on the outcome of cancer patients has been intensively studied in recent years, and several assessment tools have been proposed for nutritional screening [4]. The geriatric nutritional risk index (GNRI) was developed as a simple and objective nutritional assessment tool for hospitalized elderly patients (aged ≥ 65 years, according to World Health Organization definition of elderly; https://www.who.int/) based on their body weight and serum albumin level [5]. Believe that the GNRI accurately reflects the nutritional status of elderly cancer patients who are at risk of malnutrition because of their physiological frailty and vulnerability. The geriatric nutritional risk index (GNRI) was developed to evaluate the prognosis in elderly hospitalized patients at risk of malnutrition and related morbidity and mortality. This study aimed to evaluate the relationship between preoperative GNRI and long-term outcomes in elderly gastric cancer patients
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