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The impact of geriatric nutritional risk index on surgical outcomes after esophagectomy in patients with esophageal cancer

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Abstract

Background

Geriatric Nutritional Index (GNRI) was shown to be closely associated with nutrition-related complications and mortality in elderly hospitalized patients. Impact of GNRI on postoperative outcomes in surgically treated esophageal squamous cell carcinoma (ESCC) patients has not been evaluated extensively.

Methods

A total of 240 patients with ESCC who underwent radical esophagectomy with two- or three-field lymphadenectomy between April 2000 and April 2012 were included in this retrospective study. GNRI formula was as follows: 1.489 × albumin (g/dl) + 41.7 × current weight/ideal weight. Patients were categorized as GNRI-low (GNRI < 92) or GNRI-high (GNRI ≥ 92) according to the receiver operating characteristics (ROC) curves generated for multiple logistic regression analysis using 5-year overall survival as the end point. The impact of GNRI status on short- and long-term outcomes of curative surgery for ESCC was examined.

Results

There were 44 (18.3%) and 196 (82.7%) patients in the GNRI-low and GNRI-high groups, respectively. Among the investigated demographic factors, the rate of nodal metastasis and pathological stage were significantly higher in the GNRI-low group than in the GNRI-high group (p < 0.01 and p < 0.01, respectively). Univariate analysis of postoperative complications revealed that the rate of lung complications was significantly higher in the GNRI-low group than in the GNRI-high group (p = 0.024), while GNRI was not an independent risk factor for the development of lung complications by multivariate analysis (Odds Ratio: 1.746; p = 0.126). 5-year overall survival (OS) was significantly lower in the GNRI-low group than in the GNRI-high group (p < 0.01). Moreover, GNRI was an independent prognostic factor for OS [Hazard ratio: 1.687; 95% confidence interval (CI): 1.038–2.742; p = 0.035], but not for cancer-specific survival. Analysis with stratification by tumor stage revealed that both OS and Cancer-Specific Survival (CSS) were worse in patients with low GNRI than those with high GNRI only among those with stage III ESCC (34.4% vs. 52.1%, p = 0.049 and 36.1% vs. 57.2%, p = 0.041, respectively). In the stage III ESCC, primary tumor size tends to be greater in the GNRI-low group than in the GNRI-high group (5.69 vs. 4.75 cm, p = 0.085) and the incidence of preoperative dysphagia was significantly higher in the GNRI-low group than in the GNRI-high group (74% vs. 45.9%, p = 0.032).

Conclusion

GNRI was closely associated with long-term survival after curative surgery in patients with stage III ESCC. Intensive follow-up after surgery should be performed for ESCC patients with low GNRI.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Osaka City General Hospital, 1-4-3, Miyakojima-hondori, Miyakojima-ku, Osaka, Osaka, 545-8585, Japan

    Naoshi Kubo & Katsunobu Sakurai

  2. Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, Osaka, 545-8585, Japan

    Tatsuro Tamura, Takahiro Toyokawa, Hiroaki Tanaka, Kazuya Muguruma, Masakazu Yashiro & Masaichi Ohira

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  1. Naoshi Kubo
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  2. Katsunobu Sakurai
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  3. Tatsuro Tamura
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  4. Takahiro Toyokawa
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  5. Hiroaki Tanaka
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  6. Kazuya Muguruma
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  7. Masakazu Yashiro
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  8. Masaichi Ohira
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Correspondence to Naoshi Kubo.

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Ethical Statement

This was a retrospective study approved by the review board of Osaka City University Hospital.

Conflict of interest

The authors have no financial or other interests with regard to the submitted manuscript.

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Kubo, N., Sakurai, K., Tamura, T. et al. The impact of geriatric nutritional risk index on surgical outcomes after esophagectomy in patients with esophageal cancer. Esophagus 16, 147–154 (2019). https://doi.org/10.1007/s10388-018-0644-6

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  • DOI: https://doi.org/10.1007/s10388-018-0644-6

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