The impact of geriatric nutritional risk index on surgical outcomes after esophagectomy in patients with esophageal cancer

BackgroundGeriatric Nutritional Index (GNRI) was shown to be closely associated with nutrition-related complications and mortality in elderly hospitalized patients. Impact of GNRI on postoperative outcomes in surgically treated esophageal squamous cell carcinoma (ESCC) patients has not been evaluated extensively.MethodsA total of 240 patients with ESCC who underwent radical esophagectomy with two- or three-field lymphadenectomy between April 2000 and April 2012 were included in this retrospective study. GNRI formula was as follows: 1.489xalbumin (g/dl)+41.7xcurrent weight/ideal weight. Patients were categorized as GNRI-low (GNRI<92) or GNRI-high (GNRI92) according to the receiver operating characteristics (ROC) curves generated for multiple logistic regression analysis using 5-year overall survival as the end point. The impact of GNRI status on short- and long-term outcomes of curative surgery for ESCC was examined.ResultsThere were 44 (18.3%) and 196 (82.7%) patients in the GNRI-low and GNRI-high groups, respectively. Among the investigated demographic factors, the rate of nodal metastasis and pathological stage were significantly higher in the GNRI-low group than in the GNRI-high group (p<0.01 and p<0.01, respectively). Univariate analysis of postoperative complications revealed that the rate of lung complications was significantly higher in the GNRI-low group than in the GNRI-high group (p=0.024), while GNRI was not an independent risk factor for the development of lung complications by multivariate analysis (Odds Ratio: 1.746; p=0.126). 5-year overall survival (OS) was significantly lower in the GNRI-low group than in the GNRI-high group (p<0.01). Moreover, GNRI was an independent prognostic factor for OS [Hazard ratio: 1.687; 95% confidence interval (CI): 1.038-2.742; p=0.035], but not for cancer-specific survival. Analysis with stratification by tumor stage revealed that both OS and Cancer-Specific Survival (CSS) were worse in patients with low GNRI than those with high GNRI only among those with stage III ESCC (34.4% vs. 52.1%, p=0.049 and 36.1% vs. 57.2%, p=0.041, respectively). In the stage III ESCC, primary tumor size tends to be greater in the GNRI-low group than in the GNRI-high group (5.69 vs. 4.75cm, p=0.085) and the incidence of preoperative dysphagia was significantly higher in the GNRI-low group than in the GNRI-high group (74% vs. 45.9%, p=0.032).ConclusionGNRI was closely associated with long-term survival after curative surgery in patients with stage III ESCC. Intensive follow-up after surgery should be performed for ESCC patients with low GNRI.