Geriatric nutritional risk index as a predictor of prognosis in hepatocellular carcinoma: A systematic review and meta-analysis

Objective: The geriatric nutritional risk index (GNRI) has found utility as a predictor of outcomes in several malignancies. However, does it predicts outcomes in hepatocellular cancer (HCC) is unclear. In this review, we present high-quality evidence on the prognostic ability of GNRI for HCC. Methods: Two reviewers screened the websites of Embase, PubMed, Web of Science, and Scopus up to 20th June 2024 for relevant articles. We examined overall survival (OS) and progression-free survival (PFS) based on low vs high GNRI in HCC. Results: Total 13 studies were included. Meta-analysis of 11 studies showed that low GNRI was significantly associated with poor OS (HR: 1.83 95% CI: 1.47, 2.29 I2=67%) and PFS (HR: 1.51 95% CI: 1.34, 1.69 I2=27%.) in HCC patients. No publication bias was noted. Most outcomes did not change on subgroup analysis based on country of origin, sample size, Child-Pugh Grade-B %, treatment, cut-off, follow-up, and method of analysis. Results remained significant on sensitivity analysis. Conclusions: The GNRI can predict OS and PFS in HCC patients. Given its availability and ease of calculation, the tool can be incorporated into clinical practice to rapidly predict the prognosis of HCC patients.