Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan.
Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan.
Clin Nutr ESPEN. 2022 Jun;49:417-424. doi: 10.1016/j.clnesp.2022.03.011. Epub 2022 Mar 23.
BACKGROUND & AIMS: Malnutrition and inflammation adversely affect the prognosis of patients with cancer. The Geriatric Nutritional Risk Index (GNRI) and systemic inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), lymphocyte-to-C reactive protein ratio (LCR), and C-reactive protein-to-albumin ratio (CAR), predict survival in colorectal cancer (CRC) patients. The present study aimed to examine the association of these two factors with CRC survival.
Subjects were 433 consecutive CRC patients who underwent curative surgery between 2013 and 2018. Patients were stratified by nutritional status, and relationships between overall survival (OS) and systemic inflammation were evaluated. The prognostic impact of combinations of the GNRI and inflammatory markers was assessed. Multivariable analyses were also performed.
All assessed biomarkers predicted OS in univariable analysis (GNRI:P < 0.001, NLR:P = 0.048, LMR:P = 0.001, LCR:P = 0.010, CAR: P = 0.039). Stratified analysis showed that each inflammatory marker had a prognostic impact on OS in the low GNRI group (NLR:P = 0.028, LMR:P = 0.003, LCR:P = 0.05, CAR:P = 0.009). In contrast, inflammatory markers had no prognostic impact on OS in the high GNRI group. The combination of malnutrition and systemic inflammation had a high prognostic value (all P < 0.016). The multivariable analysis revealed that a low GNRI (hazard ratio: 2.58-2.89) was independently associated with reduced survival, whereas none of the inflammatory markers independently predicted poor prognosis.
The GNRI is a useful prognostic biomarker for CRC patients, whereas systemic inflammatory markers can only serve as prognostic factors when patient nutritional status is taken into account. The combination of malnutrition and systemic inflammation may enhance the accuracy of prognostic prediction.
营养不良和炎症会对癌症患者的预后产生不利影响。老年营养风险指数（GNRI）和全身性炎症标志物，包括中性粒细胞与淋巴细胞比值（NLR）、淋巴细胞与单核细胞比值（LMR）、淋巴细胞与 C 反应蛋白比值（LCR）和 C 反应蛋白与白蛋白比值（CAR），可预测结直肠癌（CRC）患者的生存情况。本研究旨在探讨这两个因素与 CRC 生存的关系。
本研究纳入了 2013 年至 2018 年间接受根治性手术的 433 例连续 CRC 患者。根据营养状况对患者进行分层，并评估整体生存（OS）与全身炎症之间的关系。评估了 GNRI 和炎症标志物组合的预后影响。还进行了多变量分析。
在单变量分析中，所有评估的生物标志物均预测了 OS（GNRI：P<0.001，NLR：P=0.048，LMR：P=0.001，LCR：P=0.010，CAR：P=0.039）。分层分析显示，在低 GNRI 组中，每种炎症标志物对 OS 都有预后影响（NLR：P=0.028，LMR：P=0.003，LCR：P=0.05，CAR：P=0.009）。相反，在高 GNRI 组中，炎症标志物对 OS 没有预后影响。营养不良和全身炎症的组合具有较高的预后价值（均 P<0.016）。多变量分析显示，低 GNRI（危险比：2.58-2.89）与生存时间缩短独立相关，而无任何炎症标志物独立预测预后不良。
GNRI 是 CRC 患者有用的预后生物标志物，而全身性炎症标志物只有在考虑患者营养状况时才能作为预后因素。营养不良和全身炎症的组合可能会提高预后预测的准确性。
