Lin Xiang, Wang Wei, Ding Jianming, Fei Zhaodong, Chen Chuanben
Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, 91 Maluding, Fuma Road, Fuzhou 350014, China.
Curr Oncol. 2025 Jun 26;32(7):372. doi: 10.3390/curroncol32070372.
BACKGROUND: The geriatric nutritional risk index (GNRI), a composite metric of serum albumin and body weight, has emerged as a prognostic tool in various cancers. However, its relevance in nasopharyngeal carcinoma (NPC) patients treated with volumetric modulated arc therapy (VMAT) remains unexplored. The aim of this study was to assess the effect of the GNRI in the prediction of the prognosis of nasopharyngeal carcinoma in the era of VMAT. METHODS: This retrospective study analyzed 498 newly diagnosed, non-metastatic NPC patients treated with VMAT between 2010 and 2011. The GNRI was calculated using serum albumin and body weight ratios, with receiver operating characteristic (ROC) curve analysis determining its optimal prognostic cutoff. Patients were stratified into training (70%) and validation (30%) cohorts. Cox regression identified independent prognostic factors, which were integrated into a nomogram predicting 3- and 5-year overall survival (OS). Model performance was assessed via the concordance index (C-index), calibration curves, and decision curve analysis (DCA). RESULTS: In the study, 348 patients were included in the training cohort and 150 patients were included in the validation cohort according to a ratio of 7:3. The median follow-up was 68 months, with 5-year OS rates of 79.3%. A GNRI > 102 independently predicted improved survival (HR = 0.64; = 0.044), alongside tumor volume, age, and N-stage. The nomogram demonstrated strong discrimination (C-index: 0.757-0.762 for training; 0.737-0.744 for validation) and calibration, aligning closely with observed survival. DCA confirmed superior clinical utility over default strategies. NPC patients treated with VMAT with a high GNRI, female sex, and a lower N-stage exhibited significantly better OS ( < 0.05). CONCLUSIONS: The GNRI is a robust prognostic marker for NPC patients receiving VMAT, reflecting the interplay of nutrition, inflammation, and treatment response. The validated nomogram provides a practical tool for individualized risk stratification, enhancing clinical decision-making in the era of precision radiotherapy.
背景：老年营养风险指数（GNRI）是一种综合血清白蛋白和体重的指标，已成为多种癌症的预后工具。然而，其在接受容积调强弧形放疗（VMAT）的鼻咽癌（NPC）患者中的相关性仍未得到探索。本研究的目的是评估GNRI在VMAT时代预测鼻咽癌预后中的作用。 方法：这项回顾性研究分析了2010年至2011年间498例新诊断的、非转移性NPC患者，这些患者接受了VMAT治疗。使用血清白蛋白和体重比计算GNRI，通过受试者工作特征（ROC）曲线分析确定其最佳预后临界值。患者被分为训练组（70%）和验证组（30%）。Cox回归确定独立的预后因素，并将其整合到预测3年和5年总生存率（OS）的列线图中。通过一致性指数（C指数）、校准曲线和决策曲线分析（DCA）评估模型性能。 结果：在该研究中，根据7:3的比例，348例患者被纳入训练组，150例患者被纳入验证组。中位随访时间为68个月，5年OS率为79.3%。GNRI>102独立预测生存率提高（HR = 0.64；P = 0.044），同时还有肿瘤体积、年龄和N分期。列线图显示出很强的区分能力（训练组C指数：0.757 - 0.762；验证组0.737 - 0.744）和校准能力，与观察到的生存率密切相关。DCA证实其临床实用性优于默认策略。接受VMAT治疗且GNRI高、女性和N分期较低的NPC患者表现出明显更好的OS（P < 0.05）。 结论：GNRI是接受VMAT的NPC患者的有力预后标志物，反映了营养、炎症和治疗反应之间的相互作用。经过验证的列线图为个体化风险分层提供了实用工具，增强了精准放疗时代的临床决策。
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