Prognostic value of geriatric nutritional risk index for patients with biliary tract cancer undergoing surgical resection - a single- institution retrospective cohort study

Introduction: The geriatric nutritional risk index (GNRI) is an index of nutritional status associated with clinical outcomes in various cancers; however, its prognostic value in biliary tract cancer (BTC) remains to be elucidated. This retrospective study aimed to investigate the association between preoperative GNRI and long-term prognosis of patients with BTC undergoing surgical resection. Material and methods: A total of 213 patients were included. The re-lationships between GNRI and clinicopathological variables, including inflammatory markers such as C -re-active protein (CRP) and neutrophil-to-lympho cyte ratio, were analysed. The impact of GNRI on overall survival (OS) and relapse-free survival (RFS) was investigated by Kaplan-Meier curves and Cox proportional hazards models.Results: Applying a GNRI cut-off of 98, the low-GNRI group comprised 135 patients (63%). The low-GNRI group had elevated carbohydrate antigen 19-9 and CRP levels, high rates of preoperative biliary stenting, lymph node metastases, and perineural invasion, and a lower rate of R0 resection than the high-GNRI group. Both OS and RFS in the low-GNRI group were significantly lower. In multivariate analysis, low GNRI was a significant predic-tor of poor OS (hazard ratio [HR], 1.731; 95% CI: 1.111-2.696; p = 0.015) and RFS (HR, 1.900; 95% CI: 1.231-2.931; p = 0.004), independently of inflam-matory and tumour markers, as well as of pathological features. Conclusions: Preoperative GNRI may be an easily accessible predictor of poor prognosis in patients with BTC undergoing surgical resection.