The Second Department of General Surgery, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China.
Intensive Care Unit, Lanzhou University First Hospital, Lanzhou, China.
Horm Metab Res. 2023 Oct;55(10):692-700. doi: 10.1055/a-2091-2072. Epub 2023 Jun 29.
Malnutrition is a risk factor of adverse clinical outcome in patients with cancer. Recent studies suggest that geriatric nutritional risk index (GNRI) could reflect the nutritional status in patients with various clinical conditions. The aim of the systematic review and meta-analysis was to evaluate the association between GNRI and survival of patients with hepatocellular carcinoma (HCC). Observational studies evaluating the association between pretreatment GNRI and survival of patients with HCC were obtained by search of PubMed, Web of Science, Embase, Wanfang, and CNKI databases. A random-effects model was used to pool the results after incorporating the potential influence of heterogeneity. Seven cohort studies including 2636 patients with HCC contributed to the meta-analysis. Pooled results showed that HCC patients with low pretreatment GNRI were associated with poor overall survival [hazard ratio (HR): 1.77, 95% confidence interval (CI): 1.32 to 2.37, p<0.001; I2=66%) and progression-free survival (HR: 1.62, 95% CI: 1.39 to 1.89, p<0.001; I2=0%) as compared to those with normal GNRI. Sensitivity analyses by excluding one study at a time showed similar results (p all<0.05). Subgroup analyses showed that the association between low pretreatment GNRI and poor survival of patients with HCC was not significantly affected by age of the patients, main treatment, cutoff of GNRI, or the follow-up durations. In conclusion, malnutrition indicated by a low pretreatment GNRI may be a risk factor of poor survival of patients with HCC.
营养不良是癌症患者不良临床结局的一个风险因素。最近的研究表明，老年营养风险指数（GNRI）可以反映各种临床情况下患者的营养状况。本系统评价和荟萃分析的目的是评估 GNRI 与肝细胞癌（HCC）患者生存之间的关系。通过检索 PubMed、Web of Science、Embase、万方和中国知网数据库，获得了评估预处理 GNRI 与 HCC 患者生存之间关系的观察性研究。在纳入异质性潜在影响后，使用随机效应模型对结果进行合并。有 7 项队列研究共纳入 2636 例 HCC 患者，纳入荟萃分析。汇总结果显示，预处理 GNRI 较低的 HCC 患者总体生存率较差[风险比（HR）：1.77，95%置信区间（CI）：1.32 至 2.37，p<0.001；I2=66%]和无进展生存率（HR：1.62，95%CI：1.39 至 1.89，p<0.001；I2=0%）较 GNRI 正常患者差。逐一排除一项研究的敏感性分析显示了类似的结果（p 均<0.05）。亚组分析表明，预处理 GNRI 较低与 HCC 患者生存较差之间的关联不受患者年龄、主要治疗、GNRI 截断值或随访时间的影响。总之，低预处理 GNRI 提示营养不良可能是 HCC 患者生存不良的一个危险因素。
