<p>The Value of Geriatric Nutritional Risk Index in Evaluating Postoperative Complication Risk and Long-Term Prognosis in Elderly Colorectal Cancer Patients</p>
Abstract:The geriatric nutritional risk index (GNRI) has been reported as a useful tool for predicting the prognosis of many diseases; however, there is currently little research on the relationship between GNRI and outcomes in elderly colorectal cancer (CRC) patients. This study aimed to explore the value of GNRI in evaluating postoperative complication risk and long-term prognosis in elderly CRC patients. Patients and Methods: The medical records of 230 CRC patients aged≥65 years who underwent surgery between January… Show more
“…Seven of the studies lacked relevant outcomes. Therefore, our meta-analysis included nine studies involving 2,153 patients [ 10 , 12 , 14 , 19 – 24 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Seven studies were from Japan, and two studies were from China. Two studies reported GC [ 19 , 22 ], three studies reported ESCC [ 14 , 20 , 21 ], two studies reported CRC [ 10 , 12 ], one study reported colorectal liver metastasis (CRLM) [ 24 ], and one study reported pancreatic ductal adenocarcinoma (PDAC). In addition, four studies reported postoperative complications, eight studies reported OS, two studies reported RFS, and two studies reported DFS and CSS, respectively.…”
Section: Resultsmentioning
confidence: 99%
“…Many studies have shown that malnutrition in cancer patients may increase postoperative complications and prolong hospitalization, leading to poor treatment outcomes and increased mortality [ 8 , 9 ]. Our previous studies have also demonstrated that malnutrition is associated not only with increased postoperative complications but also with poor long-term outcomes [ 10 , 11 ]. In recent years, a comprehensive malnutrition index that integrates height, weight, and serum albumin levels, geriatric nutritional risk index (GNRI), has been reported to be associated with the prognosis of multiple GI malignancies, including colorectal cancer (CRC) [ 12 ], gastric cancer (GC) [ 13 ], and esophageal squamous cell carcinoma (ESCC) [ 14 ].…”
Background
The effect of the geriatric nutritional risk index (GNRI) on the prognosis of patients with gastrointestinal malignancy remains unclear. The aim of our study was to systematically explore the value of the GNRI in evaluating postoperative complications and long-term outcomes in gastrointestinal malignancy.
Methods
A systematic literature search was conducted using electronic databases to report the impact of the GNRI on postoperative complications and long-term outcomes of patients with gastrointestinal malignancies as of August 2020. The hazard ratio (HR) with a 95% confidence interval (CI) was used to evaluate the impact of the GNRI on long-term outcomes. The risk ratio (RR) with 95% CI was used to assess the impact of the GNRI on postoperative complications.
Result
A total of nine studies with 2,153 patients were enrolled in our meta-analysis. The results suggested that a low GNRI was correlated with poor overall survival of patients with gastrointestinal malignancy (HR = 1.94, 95% CI 1.65–2.28, p < 0.001). Patients with a low GNRI had a higher risk of complications than patients with a high GNRI (OR = 2.19, 95% CI 1.57–3.05, p < 0.001). In addition, patients with a low GNRI had shorter relapse-free survival (HR = 2.45, 95% CI 1.50–4.00, p < 0.001) and disease-free survival (HR = 1.84, 95% CI 1.23–2.76, p = 0.003) than those with a high GNRI. However, the GNRI was not an independent factor affecting cancer-specific survival (HR = 1.60, 95% CI 0.91–2.82, p = 0.101).
Conclusion
Based on existing evidence, the GNRI was a valuable predictor of complications and long-term outcomes in patients with gastrointestinal malignancy.
“…Seven of the studies lacked relevant outcomes. Therefore, our meta-analysis included nine studies involving 2,153 patients [ 10 , 12 , 14 , 19 – 24 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Seven studies were from Japan, and two studies were from China. Two studies reported GC [ 19 , 22 ], three studies reported ESCC [ 14 , 20 , 21 ], two studies reported CRC [ 10 , 12 ], one study reported colorectal liver metastasis (CRLM) [ 24 ], and one study reported pancreatic ductal adenocarcinoma (PDAC). In addition, four studies reported postoperative complications, eight studies reported OS, two studies reported RFS, and two studies reported DFS and CSS, respectively.…”
Section: Resultsmentioning
confidence: 99%
“…Many studies have shown that malnutrition in cancer patients may increase postoperative complications and prolong hospitalization, leading to poor treatment outcomes and increased mortality [ 8 , 9 ]. Our previous studies have also demonstrated that malnutrition is associated not only with increased postoperative complications but also with poor long-term outcomes [ 10 , 11 ]. In recent years, a comprehensive malnutrition index that integrates height, weight, and serum albumin levels, geriatric nutritional risk index (GNRI), has been reported to be associated with the prognosis of multiple GI malignancies, including colorectal cancer (CRC) [ 12 ], gastric cancer (GC) [ 13 ], and esophageal squamous cell carcinoma (ESCC) [ 14 ].…”
Background
The effect of the geriatric nutritional risk index (GNRI) on the prognosis of patients with gastrointestinal malignancy remains unclear. The aim of our study was to systematically explore the value of the GNRI in evaluating postoperative complications and long-term outcomes in gastrointestinal malignancy.
Methods
A systematic literature search was conducted using electronic databases to report the impact of the GNRI on postoperative complications and long-term outcomes of patients with gastrointestinal malignancies as of August 2020. The hazard ratio (HR) with a 95% confidence interval (CI) was used to evaluate the impact of the GNRI on long-term outcomes. The risk ratio (RR) with 95% CI was used to assess the impact of the GNRI on postoperative complications.
Result
A total of nine studies with 2,153 patients were enrolled in our meta-analysis. The results suggested that a low GNRI was correlated with poor overall survival of patients with gastrointestinal malignancy (HR = 1.94, 95% CI 1.65–2.28, p < 0.001). Patients with a low GNRI had a higher risk of complications than patients with a high GNRI (OR = 2.19, 95% CI 1.57–3.05, p < 0.001). In addition, patients with a low GNRI had shorter relapse-free survival (HR = 2.45, 95% CI 1.50–4.00, p < 0.001) and disease-free survival (HR = 1.84, 95% CI 1.23–2.76, p = 0.003) than those with a high GNRI. However, the GNRI was not an independent factor affecting cancer-specific survival (HR = 1.60, 95% CI 0.91–2.82, p = 0.101).
Conclusion
Based on existing evidence, the GNRI was a valuable predictor of complications and long-term outcomes in patients with gastrointestinal malignancy.
“…The CONUT score, calculated based on albumin concentration, total cholesterol concentration and total lymphocyte count, is an effective and easy screening tool for evaluating immune-nutritional status. Albumin concentration is one of the most common parameters for assessing nutritional status, and albumin reduction is thought to be related to systemic inflammation affecting catabolism and anabolism of liver cells 18 . Hypoalbuminemia also may reduce patients' tolerance to surgery, leading to poorer prognosis 19 .…”
Background:
This study aimed to explore the value of controlling nutritional status (CONUT) score in assessing short-term and long-term outcomes of colorectal cancer (CRC) patients, and construct CONUT-based nomograms to predict risk of postoperative comorbidities and survival.
Methods:
We retrospectively enrolled 512 patients from 2012 to 2014. Patients were categorized into low-CONUT and high-CONUT groups. Logistic regression analysis was used to determine characteristics influencing postoperative comorbidities. Kaplan-Meier survival curve and Cox proportional hazards analysis were used to determine characteristics affecting prognosis. The receiver operating characteristic was used to compare ability of the CONUT score with other immune-nutritional indicators to predict prognosis.
Results:
Logistic regression analysis suggested that high CONUT score was an independent risk factor affecting postoperative comorbidities (odds ratio, 1.792; 95% confidence interval [CI], 1.113-2.886; P = 0.016). Patients with low-CONUT score had longer disease-free survival (DFS) (P < 0.001) and overall survival (OS) (P < 0.001) compared to those with high-CONUT score, especially at the early stage. CONUT score was an independent factor affecting both DFS (hazard ratio [HR], 1.820; 95% CI, 1.204-2.752; P = 0.005) and OS (HR, 1.815; 95% CI, 1.180-2.792; P = 0.007). The area under the curve of CONUT score was higher than for other immune-nutritional indicators. The CONUT-based nomograms had good predictive capability.
Conclusions:
CONUT score is a strong independent predictor of postoperative comorbidities and long-term outcomes in CRC patients, and might be a better prognostic factor than other immune-nutritional indicators. The CONUT-based nomograms are conducive to the individualized formulation of follow-up strategies and treatment plans.
“…Owing to its simple calculation, it has been gradually applied in the prognosis evaluation of various chronic diseases. GNRI has prognostic value in patients with esophageal cancer, [ 10 ] hepatocellular carcinoma, [ 11 ] colorectal carcinoma, [ 12 ] and non-small-cell lung carcinoma. [ 13 ] Lee et al, [ 7 ] found that GNRI is associated with the prognosis of patients with sepsis, and that patients with a lower GNRI had higher mortality rates.…”
The geriatric nutritional risk index (GNRI) is associated with the prognosis of many diseases. However, the association between the GNRI and the prognosis of patients aged ≥65 years with severe community-acquired pneumonia (SCAP) has not been studied. We aimed to evaluate the prognostic value of GNRI in elderly SCAP patients.
This study retrospectively analyzed the clinical data of 346 patients aged ≥65 years with SCAP from December 2013 to September 2019. Patients were divided into 4 groups by the GNRI. The chi-square test or student's t test was used to compare the differences between the groups. Logistic regression analysis was used to evaluate the factors that affect prognosis. The receiver operating characteristic curve was used to compare the prognostic performance of the GNRI with other indicators. A GNRI-based nomogram was established based on the result of the multivariate analysis.
Two hundred nine (60.4%) patients had a poor prognosis. GNRI scores were significantly lower in the poor prognosis group than in the group with a good prognosis. In the multivariate analysis, gender, mean arterial pressure, neutrophil counts, and the GNRI were independently correlated with the prognosis of elderly patients. The GNRI was a significantly better predictor for poor prognosis than other indicators. The GNRI-based nomogram had excellent prediction capabilities.
GNRI is a simple and effective prognostic indicator for elderly patients with SCAP, and a GNRI-based nomogram can aid in developing individualized treatment plans for elderly patients with SCAP.
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