The impact of geriatric nutritional risk index on esophageal squamous cell carcinoma patients with neoadjuvant therapy followed by esophagectomy

Pinhao Fang; Qian Yang; Jianfeng Zhou; Yushang Yang; Siyuan Luan; Xin Xiao; Xiaokun Li; Yimin Gu; Qixin Shang; Hanlu Zhang; Longqi Chen; Xiaoxi Zeng; Yong Yuan

doi:10.3389/fnut.2022.983038

The impact of geriatric nutritional risk index on esophageal squamous cell carcinoma patients with neoadjuvant therapy followed by esophagectomy

Front Nutr. 2022 Oct 20:9:983038. doi: 10.3389/fnut.2022.983038. eCollection 2022.

Authors

Pinhao Fang¹, Qian Yang², Jianfeng Zhou¹, Yushang Yang¹, Siyuan Luan¹, Xin Xiao¹, Xiaokun Li¹, Yimin Gu¹, Qixin Shang¹, Hanlu Zhang¹, Longqi Chen¹, Xiaoxi Zeng³, Yong Yuan¹

Affiliations

¹ Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China.
² Anesthesia Operation Center of West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China.
³ Biomedical Big Data Center of West China Hospital, Med+X Center for Informatics, Sichuan University, Chengdu, China.

Abstract

Background: The Geriatric Nutritional Index (GNRI) has been indicated as a nutritional index which is highly associated with complications and mortality in older hospitalized patients. Moreover, early studies had suggested that GNRI is a potential prognostic indicator for some malignances. However, the prognostic value of GNRI in esophageal squamous cell carcinoma (ESCC) patients underwent neoadjuvant therapy followed by esophagectomy remains elusive.

Materials and methods: This retrospective study incorporated 373 patients with ESCC who had underwent neoadjuvant therapy followed by radical esophagectomy at West China Hospital of Sichuan University between April 2011 and September 2021. The GNRI formula was: 1.489 × albumin (g/dl) + 41.7 × current weight/ideal weight. Patients were classified as GNRI-low (GNRI < 98.7) or GNRI high (GNRI ≥ 98.7). The association between GNRI and clinical survival status were assessed utilizing Kaplan-Meier methods and Cox regression analysis.

Results: Three hundred and seventy three patients were retrospectively included in this study. 80 (21.5%) and 293 (78.5%) patients had been divided into the GNRI-low and GNRI-high groups respectively. Pathological T stage and the rate of nodal metastasis were significantly higher in the GNRI low group than in the GNRI high group (P = 0.003 and P = 0.001, respectively) among the examined demographic parameters. Furthermore, GNRI was significantly correlated with postoperative complications, patients with lower GNRI had a higher postoperative complication rate as compared with GNRI high group [Odds ratio: 2.023; 95% confidence interval (CI): 1.208-3.389; P = 0.007]. Univariate analysis of 5-year overall survival (OS) and disease-free survival (DFS) found that the rate of survival was considerably lower in the GNRI-low group than in the GNRI-high group (P < 0.001). However, multivariate analysis demonstrated that GNRI was not an independent risk factor.

Conclusion: In patients with ESCC, low GNRI exhibited a poor nutritional indicator and related to postoperative complications after neoadjuvant therapy. Intensive follow-up after surgery should be performed for ESCC patients with low GNRI.

Keywords: esophageal cancer; geriatric nutritional risk index; neoadjuvant therapy; postoperative complications; prognosis.