Fang Pinhao, Yang Qian, Zhou Jianfeng, Yang Yushang, Luan Siyuan, Xiao Xin, Li Xiaokun, Gu Yimin, Shang Qixin, Zhang Hanlu, Chen Longqi, Zeng Xiaoxi, Yuan Yong
Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China.
Anesthesia Operation Center of West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China.
Front Nutr. 2022 Oct 20;9:983038. doi: 10.3389/fnut.2022.983038. eCollection 2022.
The Geriatric Nutritional Index (GNRI) has been indicated as a nutritional index which is highly associated with complications and mortality in older hospitalized patients. Moreover, early studies had suggested that GNRI is a potential prognostic indicator for some malignances. However, the prognostic value of GNRI in esophageal squamous cell carcinoma (ESCC) patients underwent neoadjuvant therapy followed by esophagectomy remains elusive.
This retrospective study incorporated 373 patients with ESCC who had underwent neoadjuvant therapy followed by radical esophagectomy at West China Hospital of Sichuan University between April 2011 and September 2021. The GNRI formula was: 1.489 × albumin (g/dl) + 41.7 × current weight/ideal weight. Patients were classified as GNRI-low (GNRI < 98.7) or GNRI high (GNRI ≥ 98.7). The association between GNRI and clinical survival status were assessed utilizing Kaplan-Meier methods and Cox regression analysis.
Three hundred and seventy three patients were retrospectively included in this study. 80 (21.5%) and 293 (78.5%) patients had been divided into the GNRI-low and GNRI-high groups respectively. Pathological T stage and the rate of nodal metastasis were significantly higher in the GNRI low group than in the GNRI high group ( = 0.003 and = 0.001, respectively) among the examined demographic parameters. Furthermore, GNRI was significantly correlated with postoperative complications, patients with lower GNRI had a higher postoperative complication rate as compared with GNRI high group [Odds ratio: 2.023; 95% confidence interval (CI): 1.208-3.389; = 0.007]. Univariate analysis of 5-year overall survival (OS) and disease-free survival (DFS) found that the rate of survival was considerably lower in the GNRI-low group than in the GNRI-high group ( < 0.001). However, multivariate analysis demonstrated that GNRI was not an independent risk factor.
In patients with ESCC, low GNRI exhibited a poor nutritional indicator and related to postoperative complications after neoadjuvant therapy. Intensive follow-up after surgery should be performed for ESCC patients with low GNRI.
老年营养指数（GNRI）已被视为一种与老年住院患者并发症及死亡率高度相关的营养指标。此外，早期研究表明GNRI是某些恶性肿瘤的潜在预后指标。然而，GNRI在接受新辅助治疗后行食管切除术的食管鳞状细胞癌（ESCC）患者中的预后价值仍不明确。
这项回顾性研究纳入了2011年4月至2021年9月期间在四川大学华西医院接受新辅助治疗后行根治性食管切除术的373例ESCC患者。GNRI公式为：1.489×白蛋白（g/dl）+41.7×实际体重/理想体重。患者被分为低GNRI组（GNRI<98.7）或高GNRI组（GNRI≥98.7）。利用Kaplan-Meier方法和Cox回归分析评估GNRI与临床生存状态之间的关联。
本研究回顾性纳入了373例患者。80例（21.5%）和293例（78.5%）患者分别被分为低GNRI组和高GNRI组。在所检查的人口统计学参数中，低GNRI组的病理T分期和淋巴结转移率显著高于高GNRI组（分别为P=0.003和P=0.001）。此外，GNRI与术后并发症显著相关，低GNRI组患者的术后并发症发生率高于高GNRI组[比值比：2.023；95%置信区间（CI）：1.208 - 3.389；P=0.007]。对5年总生存期（OS）和无病生存期（DFS）的单因素分析发现，低GNRI组的生存率显著低于高GNRI组（P<0.001）。然而，多因素分析表明GNRI不是独立危险因素。
在ESCC患者中，低GNRI表现为不良营养指标，且与新辅助治疗后的术后并发症相关。对于低GNRI的ESCC患者术后应进行密切随访。
