Zhang Xiaonan, Xiong Yajun, Xu Aiguo
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhongguo Fei Ai Za Zhi. 2023 Jul 20;26(7):497-506. doi: 10.3779/j.issn.1009-3419.2023.106.14.
The relationship between nutritional status and prognosis of cancer patients has emerged as a hotspot for research. The aim of this study is to explore the application value of the geriatric nutritional risk index (GNRI) in assessing the prognosis of elderly patients with non-small cell lung cancer (NSCLC), and establish a Nomogram to predict the prognosis of elderly patients with NSCLC.
The data of patients with NSCLC aged ≥65 years who were initially treated in the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2019 were retrospectively analyzed. To determine the optimal cut-off value for GNRI, receiver operating characteristic (ROC) curve was constructed, and the patients were divided into high and low GNRI groups. Kaplan-Meier curve and Log-rank test were used to compare overall survival (OS) of the two groups. Univariate and multivariate Cox regression was used to analyze the risk factors for poor prognosis in elderly patients with NSCLC. Nomogram predicting survival in elderly patients with NSCLC was constructed and validated by using R software.
Statistically significant differences in age, gender, body mass index (BMI), histological type, albumin, treatment methods, neutrophil to lymphocyte ratio (NLR), prognostic nutritional index (PNI), systemic immune-inflammation index (SII) and cytokeratin 19 fragment (CYFRA21-1) were observed between the high and low GNRI groups (P<0.05). The Kaplan-Meier curve showed a shorter OS in the low-GNRI group. Multivariate Cox regression analysis showed that CYFRA21-1>3.3 ng/mL was an independent risk factor for the development of OS in patients with NSCLC, and GNRI>97.09 was a protective factor [hazard ratio (HR)=0.52, 95% confidence interval (CI): 0.34-0.79, P<0.05]. Patients in the stage IV had a 1.98-fold increased risk of death compared with patients in the stage I (95%CI: 1.02-3.86, P<0.05). The risk of death was 3.58 times higher in patients receiving chemotherapy alone compared with those receiving combination therapy (95%CI: 2.03-6.32, P<0.05). A Nomogram constructed on the basis of GNRI, which predicted the OS of elderly patients with NSCLC with a concordance index (C-index) of 0.70 (95%CI: 0.65-0.76), and the area under the curve (AUC) for 1 and 2-year survival rates to be 0.93 (95%CI: 0.87-0.98) and 0.72 (95%CI: 0.63-0.80), respectively, and the calibration curve has a good coincidence of prediction.
High GNRI scores are significantly associated with improved survival in elderly patients with NSCLC, and reliance on cut-off values may provide the appropriate timing for nutritional support. The Nomogram constructed in this study can be used as an effective tool to predict the survival rate of elderly patients with NSCLC, which has strong clinical practicability.
营养状况与癌症患者预后之间的关系已成为研究热点。本研究旨在探讨老年营养风险指数（GNRI）在评估老年非小细胞肺癌（NSCLC）患者预后中的应用价值，并建立列线图预测老年NSCLC患者的预后。
回顾性分析2016年1月至2019年12月在郑州大学第一附属医院初治的年龄≥65岁的NSCLC患者的数据。为确定GNRI的最佳截断值，构建受试者工作特征（ROC）曲线，并将患者分为高GNRI组和低GNRI组。采用Kaplan-Meier曲线和Log-rank检验比较两组的总生存期（OS）。采用单因素和多因素Cox回归分析老年NSCLC患者预后不良的危险因素。使用R软件构建并验证预测老年NSCLC患者生存的列线图。
高GNRI组和低GNRI组在年龄、性别、体重指数（BMI）、组织学类型、白蛋白、治疗方法、中性粒细胞与淋巴细胞比值（NLR）、预后营养指数（PNI）、全身免疫炎症指数（SII）和细胞角蛋白19片段（CYFRA21-1）方面存在统计学显著差异（P<0.05）。Kaplan-Meier曲线显示低GNRI组的OS较短。多因素Cox回归分析显示，CYFRA21-1>3.3 ng/mL是NSCLC患者OS发生的独立危险因素，GNRI>97.09是保护因素[风险比（HR）=0.52，95%置信区间（CI）：0.34-0.79，P<0.05]。IV期患者的死亡风险比I期患者增加1.98倍（95%CI：1.02-3.86，P<0.05）。单纯接受化疗的患者死亡风险比接受联合治疗的患者高3.58倍（95%CI：2.03-6.32，P<0.05）。基于GNRI构建的列线图预测老年NSCLC患者OS的一致性指数（C-index）为0.70（95%CI：0.65-0.76），1年和2年生存率的曲线下面积（AUC）分别为0.93（95%CI：0.87-0.98）和0.72（95%CI：0.63-0.80），校准曲线具有良好的预测一致性。
高GNRI评分与老年NSCLC患者生存率提高显著相关，依据截断值可能为营养支持提供合适时机。本研究构建的列线图可作为预测老年NSCLC患者生存率的有效工具，具有较强的临床实用性。
