The Clinical Utility of the Geriatric Nutritional Risk Index in Predicting Postoperative Complications and Long-Term Survival in Elderly Patients with Colorectal Cancer after Curative Surgery

Abstract

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.

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

“…The median follow-up durations varied from 2.6 to 5.5 years. All of the ten cohorts reported the outcome of OS, while the outcomes of PFS were reported in six cohorts ( 39 , 41 – 43 , 45 , 46 ). Multivariate analyses were applied to present the association between GNRI and survival of RCR in all of the included studies, and confounding factors including age, sex, performance status, cancer location, stage, and treatment etc.…”

“…Subsequently, 582 studies were further removed after screening with titles and abstracts, largely because they were not relevant to the objective of the meta-analysis. Finally, 22 studies underwent full-text review, and 13 were excluded for the reasons listed in Figure 1, which eventually made 9 studies available for the metaanalysis (39)(40)(41)(42)(43)(44)(45)(46)(47).…”

“…Table 1 shows the main features of the included studies. These studies were published between 2020 and 2022, and performed in Japan (39,40,42,(45)(46)(47) and China (41,43,44). The cancer stage of the included patients varied from stage I to stage IV, and the treatments mainly included surgical resection, endoscopic submucosal dissection, and chemoradiotherapy.…”

“…Pooling the results of ten cohorts (39)(40)(41)(42)(43)(44)(45)(46)(47) showed that compared to those with higher GNRI, a lower GNRI at baseline was associated with worse OS in patients with CRC (HR 2.39, 95% CI 1.78-3.23, p<0.001; I 2 = 60%; Figure 2A). Sensitivity analysis limited to elderly patients showed consistent results (HR 2.25, 95% CI 1.59-3.18, p<0.001; I 2 = 66%; Figure 2B).…”

Combination of Geriatric Nutritional Risk Index and Carcinoembryonic Antigen to Predict the Survival of Patients With Colorectal Cancer

“…In 2005, Bouillanne et al established a geriatric nutritional risk index (GNRI) based on common serological nutritional parameters and anthropometric parameters (22) that can be used as a nutritional prognostic assessment tool for hospitalized patients. GNRI is a simple, cost-effective, and accessible biomarker, and it has increasingly been used in the prognostic evaluation of various malignancies (23)(24)(25)(26).…”