Geriatric nutritional risk index predicts clinical outcomes in hepatocellular carcinoma after transarterial chemoembolization: a retrospective cohort study

Objective: To explore the effects of geriatric nutritional risk index (GNRI) on clinical outcomes of elderly patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) and its underlying mechanisms. Method: Data from 154 HCC patients over 65 years old undergoing TACE as the initial treatment was retrospectively collected. Patients were divided into the low-risk group (GNRI >= 92) and the high-risk group (GNRI<92). Factors affecting tumor response after the first TACE were analyzed using univariate and multivariate logistic regression. A Spearman correlation was performed to assess the relationship between the GRNI and total lymphocyte count (TLC). Finally, the prognostic value of GNRI was examined using Cox regression models. Results: The GNRI score was a risk factor for the disease control rate (P=0.002). A weak but statistically significant correlation was observed between GNRI and TLC (r=0.220, P=0.006). The combination of GNRI >= 92 and TLC >= 1500 was able to exclude the occurring of progressive disease. During 5-year follow-up, the low-risk group showed statistically longer overall survival (OS) and progression-free survival (PFS) than the high-risk group (median OS=21.0 vs. 13.0 months, P=0.006; median PFS=12.0 vs. 6.0 months, P<0.001). Multivariate analyses revealed that GNRI was independently correlated with OS. Compared with the high-risk group, the low-risk group showed a lower risk of death (hazard ratio =0.622, 95% confidence interval (CI), 0.421-0.919, P=0.017). Conclusion: GNRI is an independent prognostic factor in HCC patients undergoing TACE. Aggressive nutritional intervention targeting GNRI may help improve clinical outcomes.