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The preoperative geriatric nutritional risk index predicts long-term prognosis in elderly locally advanced rectal cancer patients: a two-center retrospective cohort study

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Abstract

Background

The objective is to explore the value of preoperative geriatric nutritional risk index (GNRI) in evaluating long-term prognosis in elderly locally advanced rectal cancer (LARC) patients who accepted neoadjuvant chemoradiotherapy (NCRT) and to compare GNRI with established nutritional markers, including prognostic nutritional index (PNI) and controlling nutritional status (CONUT) score.

Methods

Preoperative GNRI was retrospectively assessed in 172 LARC patients aged ≥ 60 years who underwent radical resection after NCRT at two centers. Optimal cutoff value of GNRI was determined by X-tile program. The association of GNRI with clinicopathological parameters and nutritional markers was analyzed. The survival ability of markers was evaluated using time-dependent receiver-operating characteristic (ROC) curve analysis. Finally, survival analysis was performed using Kaplan–Meier and Cox regression analysis.

Results

GNRI was highly correlated with nutritional markers. An optimal cutoff value for the GNRI was 96. In the time-dependent ROC curve, GNRI demonstrated a stable predictive ability for both disease-free survival (DFS) and overall survival (OS). Multivariate analysis showed that GNRI was the only nutritional marker that independently predicted DFS (HR 2.457, 95% CI 1.066–5.665, P = 0.035) and OS (HR 9.002, 95% CI 3.100–26.146, P < 0.001). As an additional benefit, GNRI was able to stratify survival in subgroups of ypTNM and tumor response.

Conclusion

Preoperative GNRI is a promising predictor of long-term survival for elderly LARC patients undergoing NCRT, superior to the established nutritional markers.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Acknowledgements

Not applicable.

Funding

This work was supported by grants from Peking University Third Hospital United-Imaging Research Institution Intelligentical Imaging Joint Research & Development Center Foundation (H79462-07), the National Natural Science Foundation of China (Grant No. 62173005), the Natural Science Foundation of Beijing (Grant No.7204324), the special fund of the National Clinical Key Specialty Construction Program, P. R. China (2021), and the National multidisciplinary cooperative diagnosis and treatment capacity building project for major diseases: comprehensive diagnosis and treatment of gastrointestinal tumors.

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Author notes

  1. Siyi Lu, Xianan Li, and Xuemin Li contributed equally to this work.

Authors and Affiliations

  1. Cancer Center, Peking University Third Hospital, Beijing, 100191, China

    Siyi Lu, Wei Fu & Hao Wang

  2. Department of Radiation Oncology, Peking University People’s Hospital, Beijing, 100044, China

    Xianan Li

  3. Department of General Surgery, Cancer Center, Peking University Third Hospital, Beijing, 100191, China

    Siyi Lu & Wei Fu

  4. Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China

    Xuemin Li, Yuxia Wang, Ran Peng & Hao Wang

  5. Department of Clinical Nutrition, Peking University Third Hospital, Beijing, 100191, China

    Qiuxiang Zhang

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  1. Siyi Lu
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Contributions

SYL, XNL and XML collected and analyzed data and wrote the manuscript. XML and RP contributed to data collection. YXW and HW contributed to the follow-up. QXZ and HW provided the intellectual contributions. HW and WF supervised the project, discussed data analysis, and reviewed the manuscript.

Corresponding authors

Correspondence to Wei Fu or Hao Wang.

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The authors declare no conflict of interest.

Ethical approval

According to Helsinki Declaration tenets, the Ethics Review Board of Peking University Third Hospital approved this study (IRB00006761-M2019387).

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The Institutional Review Board of the Third Hospital of Peking University granted a waiver of informed consent.

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Lu, S., Li, X., Li, X. et al. The preoperative geriatric nutritional risk index predicts long-term prognosis in elderly locally advanced rectal cancer patients: a two-center retrospective cohort study. Aging Clin Exp Res 35, 311–321 (2023). https://doi.org/10.1007/s40520-022-02297-4

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  • DOI: https://doi.org/10.1007/s40520-022-02297-4

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