Amano Takahiro, Akiyoshi Takashi, Furuta Momoko, Saino Yoko, Mukai Toshiki, Hiyoshi Yukiharu, Nagasaki Toshiya, Yamaguchi Tomohiro, Kawachi Hiroshi, Fukunaga Yosuke
Department of Colorectal Surgery, Gastroenterology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Department of Clinical Nutrition, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Int J Colorectal Dis. 2023 May 8;38(1):119. doi: 10.1007/s00384-023-04425-6.
To investigate the clinical impact of malnutrition on the survival of older patients with advanced rectal cancer who underwent neoadjuvant chemoradiotherapy.
We investigated the clinical significance of the geriatric nutritional risk index (GNRI) in 237 patients aged over 60 years with clinical stage II/III rectal adenocarcinoma who were treated with neoadjuvant long-course chemoradiotherapy or total neoadjuvant therapy followed by radical resection from 2004 to 2017. Pre-treatment and post-treatment GNRI were evaluated, with patients split into low (< 98) and high (≥ 98) GNRI groups. The prognostic impact of pre-treatment and post-treatment GNRI levels on overall survival (OS), post-recurrence survival (PRS), and disease-free survival (DFS) was evaluated using univariate and multivariate analyses.
Fifty-seven patients (24.1%) before neoadjuvant treatment and 94 patients (39.7%) after neoadjuvant treatment were categorized with low GNRI. Pre-treatment GNRI levels were not associated with OS (p = 0.80) or DFS (p = 0.70). Patients in the post-treatment low GNRI group had significantly poorer OS than those in the post-treatment high GNRI group (p = 0.0005). The multivariate analysis showed that post-treatment low GNRI levels were independently associated with poorer OS (hazard ratio, 3.06; 95% confidence interval, 1.55-6.05; p = 0.001). Although post-treatment GNRI levels were not associated with DFS (p = 0.24), among the 50 patients with recurrence, post-treatment low GNRI levels were associated with poorer PRS (p = 0.02).
Post-treatment GNRI is a promising nutritional score associated with OS and PRS in patients over 60 years with advanced rectal cancer treated with neoadjuvant chemoradiotherapy.
探讨营养不良对接受新辅助放化疗的老年晚期直肠癌患者生存的临床影响。
我们研究了老年营养风险指数（GNRI）在2004年至2017年间接受新辅助长程放化疗或全新辅助治疗后行根治性切除术的237例60岁以上临床II/III期直肠腺癌患者中的临床意义。评估治疗前和治疗后的GNRI，患者分为低GNRI组（<98）和高GNRI组（≥98）。使用单因素和多因素分析评估治疗前和治疗后GNRI水平对总生存期（OS）、复发后生存期（PRS）和无病生存期（DFS）的预后影响。
新辅助治疗前57例患者（24.1%）和新辅助治疗后94例患者（39.7%）的GNRI较低。治疗前GNRI水平与OS（p=0.80）或DFS（p=0.70）无关。治疗后低GNRI组患者的OS明显低于治疗后高GNRI组患者（p=0.0005）。多因素分析显示，治疗后低GNRI水平与较差的OS独立相关（风险比，3.06；95%置信区间，1.55-6.05；p=0.001）。虽然治疗后GNRI水平与DFS无关（p=0.24），但在50例复发患者中，治疗后低GNRI水平与较差的PRS相关（p=0.02）。
治疗后GNRI是一个有前景的营养评分，与接受新辅助放化疗的60岁以上晚期直肠癌患者的OS和PRS相关。
