Background

Preoperative nutritional assessment of cancer patients is important to reduce postoperative complications. Several studies have reported the Geriatric Nutritional Risk Index (GNRI) to be useful in assessing underlying diseases and long-term outcomes of hospitalized patients. The present study aimed to evaluate the impact of preoperative GNRI on short- and long-term outcomes in elderly gastric cancer patients who underwent laparoscopic gastrectomy.

Methods

We retrospectively reviewed consecutive patients aged ≥ 65 years who underwent laparoscopy-assisted gastrectomy and had R0 resection for histologically confirmed gastric adenocarcinoma. The cutoff value for preoperative GNRI was determined to be 85.7 based on the incidence of postoperative complications. Patients were categorized into two groups: low GNRI group and normal GNRI group.

Results

Univariate analyses of the 303 patients revealed that the incidence of postoperative complications was significantly associated with the American Society of Anesthesiologists Physical Status classification (ASA-PS), C-reactive protein (CRP), GNRI (p < 0.001), and operative procedure. Multivariate analyses revealed that preoperative GNRI (odds ratio [OR] 2.716; 95% confidence interval [CI] 1.166–6.328; p = 0.021) and operative procedure (OR 2.459; 95% CI 1.378–4.390; p = 0.002) were independently associated with the incidence of postoperative complications.

Univariate analyses showed that overall survival (OS) was significantly associated with ASA-PS, tumor size, tumor differentiation, pathological tumor node metastasis (TNM) stage, carcinoembryonic antigen (CEA), CRP, GNRI, and postoperative complications. Multivariate analysis demonstrated that ASA-PS (hazard ratio [HR], 3.755; 95% CI 2.141–6.585; p < 0.001), tumor differentiation (HR 1.898; 95% CI 1.191–3.025; p = 0.007), CEA (HR 1.645; 95% CI 1.024–2.643; p = 0.040), and GNRI (HR 2.093; 95% CI 1.105–3.963; p = 0.023) independently predicted OS.

Conclusion

GNRI is an important predictor of postoperative complications and overall survival in elderly gastric cancer patients. It is a reliable and cost-effective prognostic indicator that should be routinely evaluated.

背景

癌症患者的术前营养评估对于减少术后并发症很重要。几项研究报告称，老年营养风险指数 (GNRI) 可用于评估住院患者的基础疾病和长期预后。本研究旨在评估术前 GNRI 对接受腹腔镜胃切除术的老年胃癌患者的短期和长期结果的影响。

方法

我们回顾性地回顾了接受腹腔镜辅助胃切除术并因组织学证实为胃腺癌而接受 R0 切除术的年龄≥ 65 岁的连续患者。根据术后并发症的发生率确定术前 GNRI 的临界值为 85.7。患者分为两组：低 GNRI 组和正常 GNRI 组。

结果

对 303 名患者的单变量分析显示，术后并发症的发生率与美国麻醉医师协会身体状况分类 (ASA-PS)、C 反应蛋白 (CRP)、GNRI ( p  < 0.001) 和手术程序显着相关。多变量分析显示，术前 GNRI（优势比 [OR] 2.716；95% 置信区间 [CI] 1.166–6.328；p  = 0.021）和手术程序（OR 2.459；95% CI 1.378–4.390；p  = 0.002）独立相关与术后并发症的发生率有关。

单变量分析显示，总生存期（OS）与ASA-PS、肿瘤大小、肿瘤分化、病理性肿瘤淋巴结转移（TNM）分期、癌胚抗原（CEA）、CRP、GNRI和术后并发症显着相关。多变量分析表明 ASA-PS（风险比 [HR]，3.755；95% CI 2.141–6.585；p  < 0.001）、肿瘤分化（HR 1.898；95% CI 1.191–3.025；p  = 0.007）、CEA（HR 1.645 ；95% CI 1.024–2.643；p  = 0.040）和 GNRI（HR 2.093；95% CI 1.105–3.963；p  = 0.023）独立预测 OS。

结论

GNRI 是老年胃癌患者术后并发症和总生存期的重要预测指标。它是一种可靠且具有成本效益的预后指标，应进行常规评估。