Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, China; Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, China; Key Laboratory of Early Prevention & Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, China.
Department of Tuina, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China.
Clin Nutr ESPEN. 2024 Feb;59:355-364. doi: 10.1016/j.clnesp.2023.12.148. Epub 2023 Dec 30.
The geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) are considered prognostic factors for several cancers. This study aimed to investigate the relationship between the GNRI and PNI for survival outcomes in patients with hepatocellular carcinoma (HCC).
We retrospectively analyzed 1666 patients with HCC who underwent hepatectomy. Restricted cubic spline regression was used to analyze the relationship between the GNRI and PNI for recurrence and mortality. Cox proportional hazards regression analysis was used to evaluate the risk factors associated with overall survival (OS) and recurrence-free survival (RFS). Interaction analysis was performed to investigate the comprehensive effects of the GNRI, PNI, and subgroup parameters on the prognosis of patients with HCC.
The risks of death and recurrence decreased rapidly and gradually stabilized as the GNRI and PNI scores increased. Patients with lower GNRI and PNI scores had significantly shorter OS and RFS rates than those with higher scores. Multivariate analysis showed that high GNRI [HR and 95%CI = 0.77 (0.70-0.85), P < 0.001] and PNI [HR and 95%CI = 0.77 (0.70-0.86), P < 0.001] scores were associated with decreased mortality risk. This trend was maintained by confounding variables in adjusted models despite partial interactions with clinical factors. The combined GNRI and PNI analysis showed that HCC patients with high GNRI and PNI had longer OS and RFS.
The GNRI and PNI showed good survival predictions in patients with HCC. Combining the GNRI with PNI may help predict the prognosis of patients (age>18 years) with HCC after hepatectomy.
老年营养风险指数（GNRI）和预后营养指数（PNI）被认为是多种癌症的预后因素。本研究旨在探讨 GNRI 和 PNI 与肝细胞癌（HCC）患者生存结局的关系。
我们回顾性分析了 1666 例接受肝切除术的 HCC 患者。采用限制性立方样条回归分析 GNRI 和 PNI 与复发和死亡的关系。采用 Cox 比例风险回归分析评估与总生存期（OS）和无复发生存期（RFS）相关的危险因素。进行交互分析，以探讨 GNRI、PNI 和亚组参数对 HCC 患者预后的综合影响。
随着 GNRI 和 PNI 评分的增加，死亡和复发的风险迅速下降并逐渐稳定。GNRI 和 PNI 评分较低的患者 OS 和 RFS 率明显低于评分较高的患者。多变量分析显示，高 GNRI [HR 和 95%CI=0.77（0.70-0.85），P<0.001]和 PNI [HR 和 95%CI=0.77（0.70-0.86），P<0.001]评分与降低死亡风险相关。尽管与临床因素存在部分相互作用，但在调整后的模型中，混杂变量仍保持这一趋势。联合 GNRI 和 PNI 分析显示，GNRI 和 PNI 高的 HCC 患者具有更长的 OS 和 RFS。
GNRI 和 PNI 对 HCC 患者的生存有较好的预测作用。将 GNRI 与 PNI 相结合可能有助于预测 HCC 患者（年龄>18 岁）肝切除术后的预后。
