Ikuta Shinichi, Nakajima Takayoshi, Fujikawa Masataka, Aihara Tsukasa, Yamanaka Naoki
Department of Surgery, Meiwa Hospital, Japan.
Contemp Oncol (Pozn). 2023;27(2):65-70. doi: 10.5114/wo.2023.127436. Epub 2023 May 22.
The geriatric nutritional risk index (GNRI) is an index of nutritional status associated with clinical outcomes in various cancers; however, its prognostic value in biliary tract cancer (BTC) remains to be elucidated. This retrospective study aimed to investigate the association between preoperative GNRI and long-term prognosis of patients with BTC undergoing surgical resection.
A total of 213 patients were included. The relationships between GNRI and clinicopathological variables, including inflammatory markers such as C-reactive protein (CRP) and neutrophil-to-lympho-cyte ratio, were analysed. The impact of GNRI on overall survival (OS) and relapse-free survival (RFS) was investigated by Kaplan-Meier curves and Cox proportional hazards models.
Applying a GNRI cut-off of 98, the low-GNRI group comprised 135 patients (63%). The low-GNRI group had elevated carbohydrate antigen 19-9 and CRP levels, high rates of preoperative biliary stenting, lymph node metastases, and perineural invasion, and a lower rate of R0 resection than the high-GNRI group. Both OS and RFS in the low-GNRI group were significantly lower. In multivariate analysis, low GNRI was a significant predictor of poor OS (hazard ratio [HR], 1.731; 95% CI: 1.111-2.696; = 0.015) and RFS (HR, 1.900; 95% CI: 1.231-2.931; = 0.004), independently of inflammatory and tumour markers, as well as of pathological features.
Preoperative GNRI may be an easily accessible predictor of poor prognosis in patients with BTC undergoing surgical resection.
老年营养风险指数（GNRI）是一种与多种癌症临床结局相关的营养状况指标；然而，其在胆道癌（BTC）中的预后价值仍有待阐明。本回顾性研究旨在探讨术前GNRI与接受手术切除的BTC患者长期预后之间的关联。
共纳入213例患者。分析了GNRI与临床病理变量之间的关系，包括炎症标志物如C反应蛋白（CRP）和中性粒细胞与淋巴细胞比值。通过Kaplan-Meier曲线和Cox比例风险模型研究GNRI对总生存期（OS）和无复发生存期（RFS）的影响。
采用GNRI临界值98，低GNRI组包括135例患者（63%）。低GNRI组的糖类抗原19-9和CRP水平升高，术前胆道支架置入、淋巴结转移和神经周围侵犯的发生率较高，R0切除率低于高GNRI组。低GNRI组的OS和RFS均显著较低。在多变量分析中，低GNRI是OS不良（风险比[HR]，1.731；95%置信区间：1.111-2.696；P = 0.015）和RFS不良（HR，1.900；95%置信区间：1.231-2.931；P = 0.004）的显著预测因素，独立于炎症和肿瘤标志物以及病理特征。
术前GNRI可能是接受手术切除的BTC患者预后不良的一个易于获得的预测指标。
