Ide Shozo, Okugawa Yoshinaga, Omura Yusuke, Yamamoto Akira, Ichikawa Takashi, Kitajima Takahito, Shimura Tadanobu, Imaoka Hiroki, Fujikawa Hiroyuki, Yasuda Hiromi, Yokoe Takeshi, Okita Yoshiki, Ohi Masaki, Toiyama Yuji
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
World J Surg Oncol. 2021 Jan 30;19(1):34. doi: 10.1186/s12957-021-02139-z.
The clinical significance of the geriatric nutritional risk index (GNRI) in locally advanced rectal cancer (LARC) patients undergoing preoperative chemoradiotherapy (CRT) followed by curative surgery has not been comprehensively evaluated.
This retrospective study enrolled 93 LARC patients diagnosed with clinical lymph node metastasis. The GNRI formula was as follows: 1.489 × albumin (g/l) + 41.7 × current weight/ideal weight. Patients were categorized as GNRI low (GNRI < 104.25) or high (GNRI > 104.25) according to the receiver operating characteristic (ROC) curve for survival analysis. The impact of GNRI status on the prognostic outcomes of curative surgery for LARC was examined.
There were 55 (59.14%) and 38 (40.86%) patients in the GNRI high and low groups, respectively. Of the investigated demographic factors, age, pathological tumor invasion, and presence of recurrence were significantly associated with the GNRI value. In Kaplan-Meier analysis, overall survival (OS) and disease-free survival (DFS) were significantly shorter in the GNRI low group (OS: p = 0.00020, DFS: p = 0.0044, log-rank test). Multivariate analysis using a Cox proportional hazards model showed that a low GNRI was an independent risk factor for poor OS (hazard ratio (HR) = 3.22; 95% confidence interval (CI), 1.37-8.23; p = 0.0068) and DFS (HR = 2.32; 95%CI = 1.15-4.79; p = 0.018). Although use of adjuvant therapy has no impact on prognosis (OS: p = 0.26, DFS: p = 0.29), low GNRI showed shorter OS and DFS in patients with pathological lymph node metastasis [ypN(+)] (OS: p = 0.033, DFS: p = 0.032, log-rank test).
GNRI is a useful marker for LARC patients diagnosed with clinical lymph node metastasis and treated by preoperative CRT followed by curative surgery. GNRI is a useful tool to identify high risk of recurrence for improving the survival in LARC patients.
老年营养风险指数（GNRI）在接受术前放化疗（CRT）后进行根治性手术的局部晚期直肠癌（LARC）患者中的临床意义尚未得到全面评估。
本回顾性研究纳入了93例诊断为临床淋巴结转移的LARC患者。GNRI计算公式如下：1.489×白蛋白（g/l）+41.7×实际体重/理想体重。根据生存分析的受试者工作特征（ROC）曲线，将患者分为GNRI低（GNRI<104.25）或高（GNRI>104.25）组。研究了GNRI状态对LARC根治性手术预后结果的影响。
GNRI高分组和低分组分别有55例（59.14%）和38例（40.86%）患者。在研究的人口统计学因素中，年龄、病理肿瘤浸润和复发情况与GNRI值显著相关。在Kaplan-Meier分析中，GNRI低分组的总生存期（OS）和无病生存期（DFS）显著缩短（OS：p=0.00020，DFS：p=0.0044，对数秩检验）。使用Cox比例风险模型进行的多因素分析显示，低GNRI是OS不良（风险比（HR）=3.22；95%置信区间（CI），1.37-8.23；p=0.0068）和DFS不良（HR=2.32；95%CI=1.15-4.79；p=0.018）的独立危险因素。虽然辅助治疗的使用对预后无影响（OS：p=0.26，DFS：p=0.29），但低GNRI在病理淋巴结转移[ypN(+)]患者中显示出较短的OS和DFS（OS：p=0.033，DFS：p=0.032，对数秩检验）。
GNRI是诊断为临床淋巴结转移并接受术前CRT后进行根治性手术的LARC患者的有用标志物。GNRI是识别复发高风险以改善LARC患者生存的有用工具。
