Abstract
Simple SummaryElderly cancer patients usually suffer with malnutrition. Preoperative malnutrition has been considered a poorer prognostic factor in cancer treatment. The geriatric nutritional risk index (GNRI) is a simple tool for predicting the risk of morbidity and mortality in elderly patients by using albumin, height, and body weight parameters. In this study, we evaluated whether GNRI is a reliable marker for postoperative complications and long-term survival. By retrospectively evaluating 1206 CRC patients aged over 75 years who underwent curative-intent surgery at Chang Gung Memorial Hospital, there were significantly more postoperative complications in the low GNRI group (p < 0.001) and GNRI was an independent risk factor for postoperative complications (HR: 1.774, p = 0.037). Overall survival and disease-free survival were significantly worse in the low GNRI group (both p < 0.001) and a GNRI < 98 was statistically identified as an independent prognostic factor for survival. Conclusively, GNRI can be a reliable biomarker in clinical practice.Research on the relationship between the geriatric nutritional risk index (GNRI) and postoperative complications/oncological outcomes in elderly colorectal cancer (CRC) patients is limited. This study investigated the prognostic value of the GNRI in aged CRC patients. We retrospectively analyzed 1206 consecutive CRC patients aged over 75 years who underwent curative-intent surgery from January 2008 to December 2015 and categorized them into high GNRI (≥98) and low GNRI (<98) groups according to a receiver operating characteristic (ROC) curve analysis. Uni- and multivariate logistic regression analysis were used to explore the association of the GNRI with postoperative complications. Kaplan–Meier survival analyses and the Cox proportional hazard model were used to explore the association between GNRI and survival. We discovered that GNRI is an independent risk factor for postoperative complications (HR: 1.774, p = 0.037). Surgical site infection, wound dehiscence and pneumonia were more common in patients with GNRI < 98. Survival analysis showed significantly worse overall survival and disease-free survival in the low GNRI group (both p < 0.001). In the multivariate analysis, GNRI < 98 was an independent risk factor for OS (HR: 1.329, p = 0.031) and DFS (HR: 1.312, p = 0.034). Thus, preoperative GNRI can be effectively used to predict postoperative complications and long-term survival in elderly CRC patients after curative surgery.
Highlights
Colorectal cancer (CRC) is the third leading malignancy and the second highest cause of cancer-related death worldwide
We demonstrated that more patients with a low geriatric nutritional risk index (GNRI) had right-sided origin CRC and advanced staging, which is comparable with our previous study that showed that right-sided colon cancer is accompanied with more malnutrition
Our findings suggested that a low preoperative GNRI (
Summary
Colorectal cancer (CRC) is the third leading malignancy and the second highest cause of cancer-related death worldwide. According to GLOBOCAN statistics, there were more than 1.9 million new CRC cases and 935,000 related deaths estimated in 2020 [1]. In the United States, an estimated 54% of new CRC cases in 2020 occurred in patients over 65 years of age [2]. Cancer patients usually have several comorbidities [3] accompanied by malnutrition [4,5,6]. Several studies have revealed that pretreatment malnutrition status is a risk factor for posttreatment complications and worse oncologic outcomes [7,8]. A validated tool for examining nutritional status is important for risk stratification and for determining the optimal treatments for elderly patients
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