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Geriatric nutritional risk index predicts cancer prognosis in patients with local advanced rectal cancer undergoing chemoradiotherapy followed by curative surgery
Yuji Toiyama
Mie University
Corresponding Author
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Aim: The clinical significance of the geriatric nutritional risk index (GNRI) in locally advancer rectal cancer (LARC) patients undergoing preoperative chemoradiotherapy (CRT) followed by curative surgery has not been comprehensively evaluated.
Methods: This retrospective study enrolled 93 LARC patients diagnosed with clinical lymph node metastasis. The GNRI formula was as follows: 1.489×albumin (g/dl)+41.7×current weight/ideal weight. Patients were categorized as GNRI low (GNRI <104.25) or high (GNRI >104.25) according to the receiver operating characteristic (ROC) curve for survival analysis. The impact of GNRI status on the prognostic outcomes of curative surgery for LARC was examined.
Results: There were 55 (59.14%) and 3841 (40.86%) patients in the GNRI high and low groups, respectively. Of the investigated demographic factors, age, clinical tumor invasion, C-reactive protein (CRP)/albumin ratio (CAR), prognostic nutritional index (PNI) and modified Glasgow Prognostic Score (mGPS) were significantly associated with the GNRI value. In Kaplan–Meier analysis, overall survival (OS) and disease-free survival (DFS) were significantly shorter in the GNRI low group (OS: p=0.00020, DFS: p=0.0044, log-rank test). Multivariate analysis using a Cox proportional hazards model showed that a low GNRI was an independent risk factor for poor OS [hazard ratio (HR) =3.22; 95% confidence interval (CI), 1.37–8.23; p=0.0068) and DFS (HR=2.32; 95%CI=1.15-4.79; p=0.018). Additionally, for patients with pathological lymph node metastasis [ypN(+)], those with a low GNRI showed shorter OS and DFS (OS: p=0.033, DFS: p=0.032, log-rank test).
Conclusions: GNRI is a useful marker for LARC patients diagnosed with clinical lymph node metastasis and treated by preoperative CRT followed by curative surgery.
Keywords
rectal cancer, geriatric nutritional index, chemoradiotherapy, prognosis
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Received 01 Oct, 2020
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Received 30 Sep, 2020
Review #8 received
Received 27 Sep, 2020
Reviewer #8 agreed
On 26 Sep, 2020
Reviewer #7 agreed
On 25 Sep, 2020
Reviewer #3 agreed
On 24 Sep, 2020
Reviewer #4 agreed
On 24 Sep, 2020
Reviewer #5 agreed
On 24 Sep, 2020
Reviewer #6 agreed
On 24 Sep, 2020
Review #2 received
Received 23 Sep, 2020
Reviewers invited
Invitations sent on 23 Sep, 2020
Reviewer #1 agreed
On 23 Sep, 2020
Reviewer #2 agreed
On 23 Sep, 2020
Review #1 received
Received 23 Sep, 2020
First submitted
On 21 Sep, 2020
Editor assigned
On 21 Sep, 2020
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On 20 Sep, 2020
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This preprint is under consideration at World Journal of Surgical Oncology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Geriatric nutritional risk index predicts cancer prognosis in patients with local advanced rectal cancer undergoing chemoradiotherapy followed by curative surgery
Yuji Toiyama
Mie University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 23 Sep, 2020
No community comments so far
Editorial decision: Major Revision
On 09 Oct, 2020
Review #7 received
Received 08 Oct, 2020
Review #3 received
Received 05 Oct, 2020
Review #5 received
Received 01 Oct, 2020
Review #6 received
Received 01 Oct, 2020
Review #4 received
Received 30 Sep, 2020
Review #8 received
Received 27 Sep, 2020
Reviewer #8 agreed
On 26 Sep, 2020
Reviewer #7 agreed
On 25 Sep, 2020
Reviewer #3 agreed
On 24 Sep, 2020
Reviewer #4 agreed
On 24 Sep, 2020
Reviewer #5 agreed
On 24 Sep, 2020
Reviewer #6 agreed
On 24 Sep, 2020
Review #2 received
Received 23 Sep, 2020
Reviewers invited
Invitations sent on 23 Sep, 2020
Reviewer #1 agreed
On 23 Sep, 2020
Reviewer #2 agreed
On 23 Sep, 2020
Review #1 received
Received 23 Sep, 2020
First submitted
On 21 Sep, 2020
Editor assigned
On 21 Sep, 2020
Submission checks complete
On 20 Sep, 2020
Editor invited
On 20 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Aim: The clinical significance of the geriatric nutritional risk index (GNRI) in locally advancer rectal cancer (LARC) patients undergoing preoperative chemoradiotherapy (CRT) followed by curative surgery has not been comprehensively evaluated.
Methods: This retrospective study enrolled 93 LARC patients diagnosed with clinical lymph node metastasis. The GNRI formula was as follows: 1.489×albumin (g/dl)+41.7×current weight/ideal weight. Patients were categorized as GNRI low (GNRI <104.25) or high (GNRI >104.25) according to the receiver operating characteristic (ROC) curve for survival analysis. The impact of GNRI status on the prognostic outcomes of curative surgery for LARC was examined.
Results: There were 55 (59.14%) and 3841 (40.86%) patients in the GNRI high and low groups, respectively. Of the investigated demographic factors, age, clinical tumor invasion, C-reactive protein (CRP)/albumin ratio (CAR), prognostic nutritional index (PNI) and modified Glasgow Prognostic Score (mGPS) were significantly associated with the GNRI value. In Kaplan–Meier analysis, overall survival (OS) and disease-free survival (DFS) were significantly shorter in the GNRI low group (OS: p=0.00020, DFS: p=0.0044, log-rank test). Multivariate analysis using a Cox proportional hazards model showed that a low GNRI was an independent risk factor for poor OS [hazard ratio (HR) =3.22; 95% confidence interval (CI), 1.37–8.23; p=0.0068) and DFS (HR=2.32; 95%CI=1.15-4.79; p=0.018). Additionally, for patients with pathological lymph node metastasis [ypN(+)], those with a low GNRI showed shorter OS and DFS (OS: p=0.033, DFS: p=0.032, log-rank test).
Conclusions: GNRI is a useful marker for LARC patients diagnosed with clinical lymph node metastasis and treated by preoperative CRT followed by curative surgery.
Figure 1
Figure 2
Figure 3