Geriatric Nutritional Risk Index and Survival of Patients With Colorectal Cancer: A Meta-Analysis

Abstract

BackgroundGeriatric nutritional risk index (GNRI) is an indicator of nutritional status derived by serum albumin level and ideal body weight, which has been proposed as a predictor of prognosis for elderly population with various clinical conditions. The objective of the meta-analysis was to comprehensively evaluate the association between baseline GNRI and survival of patients with colorectal cancer (CRC).MethodsCohort studies were identified by search of PubMed, Embase, and Web of Science databases from inception to January 05, 2022 according to the aim of the meta-analysis. A random-effect model incorporating the potential between-study heterogeneity was adopted to pool the results.ResultsNine studies including 3658 patients with CRC contributed to the meta-analysis. Results showed that CRC patients with lower GNRI at baseline had worse overall survival (OS, hazard ratio [HR] 2.39, 95% confidence interval [CI] 1.78-3.23, p<0.001; I2 = 60%) and progression-free survival (PFS, HR 1.77, 95% CI 1.38-2.26, p<0.001; I2 = 33%). The results were consistent in sensitivity analyses limited to elderly patients (HR for OS 2.25, p<0.001; HR for PFS 1.65, p=0.003). Subgroup analyses showed consistent results in patents with different cancer stages, and in studies with median follow-up < and ≥ 5 years (p for subgroup effects all < 0.05).ConclusionA lower GNRI at baseline may be independent associated with poor survival outcomes of patients with CRC. Evaluating the nutritional status using GNRI may be important for risk stratification of patients with CRC.

Nutritional Status and Cancer: Early Detection of Malnutrition and Sarcopenia in Elderly Patients at High Risk for Cachexia by Using a Multi-Score Protocol

“…However, patients who reported the lowest values of serum albumin were mainly suffering from gastrointestinal tumors demonstrating a major risk of malnutrition with respect to patients affected by other types of tumors. This aspect was also demonstrated by the GNRI score, which showed the greatest nutritional risk more than all the other instruments used [39,40]. The accuracy of GNRI allowed early detection in patients where other tests did not detect the problem.…”

Prognostic and clinicopathological value of the geriatric nutritional risk index in gastric cancer: A meta-analysis of 5,834 patients

“…Nomograms based on these parameters can also be explored in future studies. Many meta-analyses have recently reported the prognostic significance of the GNRI in a variety of solid tumors (31)(32)(33)(34)(35). A recent meta-analysis including 3,981 patients showed the pretreatment GNRI was significantly associated with prognosis in patients with esophageal cancer, and a lower GNRI predicted a worse survival rate (32).…”

Predictive role of preoperative geriatric nutritional risk index for clinical outcomes in surgical gastric cancer patients: A meta-analysis

“…To date, multiple meta-analyses have explored the prognostic role of the GNRI in cancer patients. Zhao et al included nine studies involving 3,658 participants and demonstrated that colorectal cancer patients with a lower baseline GNRI showed worse OS (HR = 2.39, 95% CI: 1.78–3.23, P < 0.001) and progression-free survival (PFS) (HR = 1.77, 95% CI: 1.38–2.26, P < 0.001) ( 14 ). Sun et al showed that a lower GNRI was significantly related to poor OS (HR = 2.01, 95% CI: 1.65–2.44, P < 0.001) and PFS/CSS (HR = 1.81, 95% CI: 1.48–2.22, P < 0.001) ( 16 ).…”

“…The inclusion criteria were as follows: (1) patients were pathologically diagnosed with gastric cancer; (2) patients received surgical treatment, and GNRI was calculated as [1.489 × serum albumin level (in g/l)] + [41.7 × present weight/ideal weight (in kg)] before the surgery ( 14 ); (3) the association of preoperative GNRI with postoperative overall survival (OS), cancer-specific survival (CSS) or complications was explored; and (4) hazard ratios (HRs) with 95% confidence intervals (CIs) for OS and CSS were reported in the articles directly.…”

“…It is calculated as 1.489 × serum albumin level (in g/l) + 41.7 × present weight/ideal weight (in kg), which indicates its stability to some extent. Furthermore, its prognostic role has been verified in several types of cancers, such as colorectal cancer, lung cancer and esophageal cancer, by meta-analyses (13)(14)(15)(16)). However, its predictive role in short-term and long-term prognosis in surgical gastric cancer remains unclear.…”