Geriatric nutritional risk index as a prognostic marker for patients with upper tract urothelial carcinoma receiving radical nephroureterectomy

Abstract

To investigate the prognostic value of the geriatric nutritional risk index (GNRI) in patients with upper tract urothelial cell carcinoma (UTUC) receiving radical nephroureterectomy (RNU). Between January 2001 and December 2015, we enrolled 488 patients with UTUC underwent RNU in Taichung Veterans General Hospital. GNRI before radical surgery was calculated based on serum albumin level and body mass index. The malnutritional status was defined as GNRI < 92.0. Using Kaplan–Meier analyses and Cox proportional hazards models to analyze the risk factors on disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS). 386 patients were categorized as normal nutritional status (GNRI ≥ 92) and 102 patients as malnutritional status (GNRI < 92). We used the receiver operating characteristic (ROC) curve for determined the association between GNRI and OS, with area under the curve (AUC) being 0.69. The 5-year survival rate of DFS, CSS and OS were 48.6%, 80.5% and 80.5% in the normal nutritional group and 28.0%, 53.2% and 40% in the malnutritional group. Using the multivariate analysis, malnutritional status was found as an independent risk factor for OS (hazard ratio [HR] = 3.94, 95% confidence interval [CI] 2.70–5.74), together with age (HR = 1.04, 95% CI 1.02–1.06), surgical margin positive (HR = 1.78, 95% CI 1.13–2.82), pathological T3 (HR = 2.54, 95% CI 1.53–4.21), pathological T4 (HR = 6.75, 95% CI 3.17–14.37) and lymphovascular invasion (HR = 1.81, 95% CI 1.16–2.81). We also found GNRI index as independent risk factor in DFS (HR = 1.90, 95% CI 1.42–2.54) and CSS (HR = 5.42, 95% CI 3.24–9.06). Preoperative malnutritional status with low GNRI is an independent marker in predicting DFS, CSS and OS in UTUC patients underwent RNU.

Prognostic utility of the geriatric nutritional risk index for head and neck cancer: Systematic review and meta‐analysis

“…Moreover, there are reports assessing GNRI as a prognostic biomarker, encompassing younger patients with cancer, indicating that GNRI is associated with poor prognosis in various malignancies and can be applied not only in elderly patients but also in young patients. [14][15][16][17][18] However, its prognostic utility for patients with HNC has not been consistently demonstrated. Research has reported an association of low GNRI scores with unfavorable survival outcomes in patients with HNC.…”