Journal Article

Geriatric nutritional risk index predicts cancer prognosis in patients with local advanced rectal cancer undergoing chemoradiotherapy followed by curative surgery

Ide, Shozo, Ohi, Masaki, Okita, Yoshiki, Omura, Yusuke, Toiyama, Yuji, Imaoka, Hiroki, Yasuda, Hiromi, Ichikawa, Takashi, Yokoe, Takeshi, Fujikawa, Hiroyuki, Yamamoto, Akira, Okugawa, Yoshinaga, Shimura, Tadanobu, Kitajima, Takahito

2021

Overview

Aim The clinical significance of the geriatric nutritional risk index (GNRI) in locally advanced rectal cancer (LARC) patients undergoing preoperative chemoradiotherapy (CRT) followed by curative surgery has not been comprehensively evaluated. Methods This retrospective study enrolled 93 LARC patients diagnosed with clinical lymph node metastasis. The GNRI formula was as follows: 1.489 × albumin (g/l) + 41.7 × current weight/ideal weight. Patients were categorized as GNRI low (GNRI < 104.25) or high (GNRI > 104.25) according to the receiver operating characteristic (ROC) curve for survival analysis. The impact of GNRI status on the prognostic outcomes of curative surgery for LARC was examined. Results There were 55 (59.14%) and 38 (40.86%) patients in the GNRI high and low groups, respectively. Of the investigated demographic factors, age, pathological tumor invasion, and presence of recurrence were significantly associated with the GNRI value. In Kaplan–Meier analysis, overall survival (OS) and disease-free survival (DFS) were significantly shorter in the GNRI low group (OS: p  = 0.00020, DFS: p  = 0.0044, log-rank test). Multivariate analysis using a Cox proportional hazards model showed that a low GNRI was an independent risk factor for poor OS (hazard ratio (HR) = 3.22; 95% confidence interval (CI), 1.37–8.23; p  = 0.0068) and DFS (HR = 2.32; 95%CI = 1.15–4.79; p  = 0.018). Although use of adjuvant therapy has no impact on prognosis (OS: p  = 0.26, DFS: p  = 0.29), low GNRI showed shorter OS and DFS in patients with pathological lymph node metastasis [ypN(+)] (OS: p  = 0.033, DFS: p  = 0.032, log-rank test). Conclusions GNRI is a useful marker for LARC patients diagnosed with clinical lymph node metastasis and treated by preoperative CRT followed by curative surgery. GNRI is a useful tool to identify high risk of recurrence for improving the survival in LARC patients.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Aged / Albumins / Antigens / Cancer / Cancer therapies / Care and treatment / Chemoradiotherapy / Chemotherapy / Colorectal cancer / Confidence intervals / Current Evidence and Future Directions in the Treatment of Colorectal Cancer / Geriatric assessment / Geriatric nutritional index / Geriatrics / Health hazards / Health risks / Humans / Impact analysis / Lymph nodes / Lymphatic system / Malnutrition / Medical prognosis / Medicine / Medicine & Public Health / Metastases / Metastasis / Mortality / Multivariate analysis / Neoplasm Recurrence, Local - therapy / Nutrition / Patient outcomes / Patients / Product/Service Evaluations / Prognosis / Radiation therapy / Radiotherapy / Rank tests / Rectal cancer / Rectal Neoplasms - drug therapy / Rectum / Retrospective Studies / Risk analysis / Risk factors / Statistical models / Surgery / Surgical Oncology / Survival / Weight