Purpose: The geriatric nutritional risk index (GNRI) has been reported as a useful tool for predicting the prognosis of many diseases; however, there is currently little research on the relationship between GNRI and outcomes in elderly colorectal cancer (CRC) patients. This study aimed to explore the value of GNRI in evaluating postoperative complication risk and long-term prognosis in elderly CRC patients.
Patients and Methods: The medical records of 230 CRC patients aged≥65 years who underwent surgery between January 2012 and December 2014 were retrospectively analyzed. Patients were divided into abnormal and normal GNRI groups by modified binary classification. Logistic regression analysis was used to evaluate the correlation between GNRI and complication risk. The Kaplan–Meier method with log-rank test was used to construct survival curves. The Cox proportional hazard model was used for univariate, multivariate and subgroup survival analyses to assess the relationship between GNRI and long-term prognosis.
Results: Multivariate logistic regression analysis showed that GNRI (p = 0.009, HR 2.280, 95% CI: 1.224–4.247) was an independent risk factor for postoperative complications in elderly CRC patients. Kaplan–Meier survival curves revealed that the abnormal GNRI group had significantly lower disease-free survival (DFS; p = 0.005) and overall survival (OS; p=0.007) than the normal GNRI group had, especially in TNM I stage. In multivariate survival analysis, GNRI was an independent prognostic factor for DFS (p = 0.003, HR 1.842, 95% CI: 1.229–2.760) and OS (p = 0.003, HR 1.852, 95% CI: 1.231–2.787).
Conclusion: GNRI is a simple and effective tool for predicting the risk of postoperative complications and the long-term prognosis of postoperative elderly CRC patients and can provide a scientific basis for early nutrition interventions in elderly CRC patients.


Keywords: colorectal cancer, geriatric nutritional risk index, prognosis, complication


INTRODUCTION

Colorectal cancer (CRC) is the third most frequent malignancy and the second leading cause of cancer-related death worldwide, and its incidence ranks fourth among men and third among women. In 2018, there were >1.8 million new cases and 881,000 deaths estimated worldwide.1 In China, CRC is the fifth most usual malignancy, and its mortality ranks fourth, and the incidence continues to increase.2

Surgical resection is still a mainstay of curative treatment for CRC.3 However, malnutrition may increase the risk of surgery and prolong hospital stays and has been confirmed to significantly increase postoperative mortality in elderly patients.4 Malnutrition is often found in cancer patients and is not only associated with postoperative complications, but also with long-term prognosis.5,6 A large body of research has reported malnutrition in >80% of patients with gastrointestinal malignancies.7,8 Therefore, further studies are needed to determine prognostic indicators to assess better the risk of postoperative complications and long-term prognosis in elderly CRC patients.

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The geriatric nutritional risk index (GNRI) was originally established by Bouillanne et al9 to assess nutritional risk in elderly people. GNRI is an adaptation of the NRI of Buzby et al10 and it is a simple nutrition screening tool for assessing the nutritional risks for elderly patients.11,12 GNRI is widely used in nutritional assessment of elderly patients with chronic liver failure, chronic obstructive pulmonary disease, and cardiovascular disease.13–15 Recently, many studies have found that GNRI can be used in the prognostic assessment of various malignant tumors, including renal cell carcinoma,16,17 esophageal squamous cell carcinoma,18 hepatocellular carcinoma,19 and pathological stage I non-small cell lung cancer.20 However, there is currently little research on the relationship between GNRI and outcomes in elderly CRC patients. Thus, this study aimed to explore the value of GNRI in evaluating postoperative complication risk and long-term prognosis in elderly CRC patients.

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