An Soomin, Eo Wankyu, Lee Sookyung
Department of Nursing, Dongyang University, Gyeongbuk, Republic of Korea.
College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
J Cancer. 2022 Sep 21;13(12):3348-3357. doi: 10.7150/jca.77397. eCollection 2022.
The geriatric nutritional risk index (GNRI) is an important determinant of overall survival (OS) in patients with stage I-III gastric cancer (GC) across all ages; however, its value as a determinant of disease-free survival (DFS) is unclear. Moreover, the prognostic values between the GNRI and prognostic nutritional index (PNI) remains unclear. We retrospectively evaluated the value of the GNRI and PNI as determinants of OS and DFS in patients with stage I-III GC who underwent curative-intent gastrectomy. Cox regression analysis was used for evaluating the determinants of survival outcomes. The discriminative capacity of the prognostic model was determined using the concordance index (C-index), and then C-indices of related models were compared. Data from 450 patients were analyzed. The median patient age was 60 years (range: 26-92 years). In total, 276 (61.3%) patients had stage I cancer, 83 (18.4%) had stage II cancer, and 91 (20.2%) had stage III cancer. Multivariate Cox regression analysis revealed that age, type of gastrectomy (TOG), T stage, tumor-node-metastasis (TNM) stage, and GNRI were determinants of OS. These five covariates constituted the GNRI model for the OS. In addition, multivariate analysis revealed that age, TOG, TNM stage, and GNRI were determinants of DFS. These four covariates constituted the GNRI model for DFS. When constructing the PNI model for OS (comprising age, TOG, T stage, TNM stage, and PNI), and PNI model for DFS (including age, TOG, TNM stage, and PNI), the C-indices of the GNRI and PNI models were nearly equal for OS (0.818 and 0.818, respectively; =0.909) and DFS (0.805 and 0.808, respectively; =0.653). Using the GNRI models, nomograms for predicting OS and DFS were established. When validating the nomograms using calibration curves, the predicted survival closely matched the actual survival rate. : The GNRI and PNI were important determinants of both OS and DFS in patients with GC across all ages. In addition, the effects of the GNRI model on OS and DFS were similar to those of the PNI model.
老年营养风险指数（GNRI）是各年龄段I - III期胃癌（GC）患者总生存期（OS）的重要决定因素；然而，其作为无病生存期（DFS）决定因素的价值尚不清楚。此外，GNRI与预后营养指数（PNI）之间的预后价值仍不明确。我们回顾性评估了GNRI和PNI作为接受根治性胃切除术的I - III期GC患者OS和DFS决定因素的价值。采用Cox回归分析评估生存结局的决定因素。使用一致性指数（C指数）确定预后模型的鉴别能力，然后比较相关模型的C指数。分析了450例患者的数据。患者中位年龄为60岁（范围：26 - 92岁）。总共，276例（61.3%）患者为I期癌症，83例（18.4%）为II期癌症，91例（20.2%）为III期癌症。多因素Cox回归分析显示，年龄、胃切除术类型（TOG）、T分期、肿瘤 - 淋巴结 - 转移（TNM）分期和GNRI是OS的决定因素。这五个协变量构成了OS的GNRI模型。此外，多因素分析显示，年龄、TOG、TNM分期和GNRI是DFS的决定因素。这四个协变量构成了DFS的GNRI模型。在构建OS的PNI模型（包括年龄、TOG、T分期、TNM分期和PNI）和DFS的PNI模型（包括年龄、TOG、TNM分期和PNI）时，OS的GNRI和PNI模型的C指数几乎相等（分别为0.818和0.818；P = 0.909），DFS的C指数也几乎相等（分别为0.8— 5和0.808；P = 0.653）。使用GNRI模型，建立了预测OS和DFS的列线图。使用校准曲线验证列线图时，预测生存率与实际生存率密切匹配。结论：GNRI和PNI是各年龄段GC患者OS和DFS的重要决定因素。此外，GNRI模型对OS和DFS的影响与PNI模型相似。
