Teraishi Fuminori, Utsumi Masashi, Yoshida Yusuke, Shoji Ryohei, Kanaya Nobuhiko, Matsumi Yuki, Shigeyasu Kunitoshi, Kondo Yoshitaka, Itagaki Shiori, Tamura Rie, Matsuoka Yoshikazu, Fujiwara Toshiyoshi, Inagaki Masaru
Department of Surgery, National Hospital Organization Fukuyama Medical Center, Hiroshima, Japan;
Department of Gastroenterological Surgery, Okayama University Hospital, Okayama, Japan.
In Vivo. 2025 Sep-Oct;39(5):2810-2817. doi: 10.21873/invivo.14080.
BACKGROUND/AIM: Colorectal cancer (CRC) presents a significant challenge in oldest-old patients (≥85 years), where surgical intervention carries substantial perioperative risks. Nutritional status is a crucial determinant of outcomes, and the Geriatric Nutritional Risk Index (GNRI) has shown promise. This prospective study aimed to validate the GNRI as a key indicator of perioperative outcomes in oldest-old patients undergoing CRC surgery, and to establish its utility in preoperative risk stratification.
This prospective study enrolled patients aged ≥85 years undergoing elective surgery for CRC. Preoperative GNRI was calculated using the formula: GNRI=14.89×serum albumin (g/dl)+41.7×[actual body weight/ideal body weight (corresponding to body mass index 22)]. Patients were stratified into two groups: GNRI >98 and GNRI ≤98. Baseline demographics, clinical characteristics, geriatric assessments (including Geriatric-8 and EuroQol 5 dimension), and postoperative complication rates were analyzed.
Twenty-four patients (median age 88 years, interquartile range=86-91) were included: 11 in the GNRI >98 group and 13 in the GNRI ≤98 group. The patients with GNRI >98 demonstrated significantly better G8 scores (median 12 11, <0.01) and EQ-5D index values (median 88 75.0, <0.01). The postoperative complication rate was significantly higher in the GNRI ≤98 group (=0.02).
Preoperative GNRI effectively identifies oldest-old patients with CRC at increased risk for postoperative complications. A GNRI ≤98 correlates with poorer nutritional status and impaired geriatric functional parameters. These findings highlight GNRI's utility as a simple, valuable tool for preoperative risk stratification, potentially guiding interventions to optimize outcomes in this vulnerable population.
背景/目的：结直肠癌（CRC）给高龄患者（≥85岁）带来了重大挑战，此类患者进行手术干预会面临较高的围手术期风险。营养状况是预后的关键决定因素，老年营养风险指数（GNRI）已显示出一定前景。本前瞻性研究旨在验证GNRI作为高龄CRC手术患者围手术期预后的关键指标，并确定其在术前风险分层中的作用。
本前瞻性研究纳入了年龄≥85岁、接受择期CRC手术的患者。术前GNRI采用以下公式计算：GNRI = 14.89×血清白蛋白（g/dl）+ 41.7×[实际体重/理想体重（对应体重指数22）]。患者被分为两组：GNRI > 98和GNRI ≤ 98。分析了基线人口统计学、临床特征、老年评估（包括老年综合评估8项和欧洲五维健康量表）及术后并发症发生率。
共纳入24例患者（中位年龄88岁，四分位间距 = 86 - 91岁）：GNRI > 98组11例，GNRI ≤ 98组13例。GNRI > 98的患者G8评分显著更高（中位数12对11，P < 0.01），EQ - 5D指数值也显著更高（中位数88对75.0，P < 0.01）。GNRI ≤ 98组的术后并发症发生率显著更高（P = 0.02）。
术前GNRI能有效识别术后并发症风险增加的高龄CRC患者。GNRI ≤ 98与较差的营养状况及受损的老年功能参数相关。这些发现凸显了GNRI作为一种简单且有价值的术前风险分层工具的作用，可能为优化这一脆弱人群的预后提供干预指导。
