Geriatric nutritional risk index after neoadjuvant chemoradiotherapy and survival in older patients with advanced rectal cancer

Abstract

PurposeTo investigate the clinical impact of malnutrition on survival in older patients with advanced rectal cancer undergoing neoadjuvant chemoradiotherapy.Methods We investigated the clinical signi cance of the geriatric nutrition risk index (GNRI) in 237 patients older than 60 with clinical stage II/III rectal adenocarcinoma treated with neoadjuvant longcourse chemoradiotherapy or total neoadjuvant therapy followed by radical resection from 2004 to 2017.Pre-treatment and post-treatment GNRI were evaluated, and patients were divided into low (<98) and high (≥98) GNRI groups. The prognostic impact of pre-treatment and post-treatment GNRI levels on overall survival and disease-free survival were evaluated using univariate and multivariate analyses.Results Fifty-seven patients (24.1%) before neoadjuvant treatment and 94 patients (39.7%) after neoadjuvant treatment were categorized as low GNRI. Pre-treatment GNRI levels were not associated with overall survival (p = 0.80) or disease-free survival (p = 0.77). Patients in the post-treatment low GNRI group had signi cantly poorer overall survival than those in the post-treatment high GNRI group (p = 0.0005). The multivariate analysis showed that post-treatment low GNRI levels were independently associated with poorer overall survival (hazard ratio, 3.25; 95% con dence interval, 1.26-8.36; p = 0.02). Although post-treatment GNRI levels were not associated with disease-free survival (p= 0.24), among the 50 patients with recurrence, post-treatment low GNRI levels were associated with poorer post-recurrence survival (p = 0.006). ConclusionPost-treatment GNRI is a promising nutritional score associated with overall survival and post-recurrence survival in older patients with advanced rectal cancer treated with neoadjuvant chemoradiotherapy.

Significance of Nutritional-Inflammatory Index as Predictors for Total Neoadjuvant Therapy-Induced Tumor Regression in Locally Advanced Rectal Cancer Patients

“…32 In particular, Zhang and Amano et al highlighted the importance of post-nCRT GNRI in predicting overall survival and PFS for patients with LARC over 60 years of age. 33,34 However, our study, with only 39 (30.7%) patients over 60 years of age, did not observe a similar correlation (Table 2).…”