Geriatric Nutritional Risk Index as a prognostic factor in patients with esophageal squamous cell carcinoma -retrospective cohort study

Purpose: The Geriatric Nutritional Risk Index (GNRI) is a new index recently introduced to predict the risk of nutrition-related complications and mortality. Our aim is to examine the association between the GNRI and long-term prognosis in patients with esophageal squamous cell carcinoma (ESCC) who underwent esophagectomy. Methods: The present study enrolled consecutive 216 patients with ESCC who underwent esophagectomy. The GNRI at admission to the hospital was calculated as follows: (1.489 x albumin, g/l) + (41.7 x present/ideal body weight). The characteristics and long-term prognosis were compared between four groups: the severe risk (GNRI: < 82), moderate risk (GNRI: 82 to < 92), low risk (GNRI: 92 to < 98) and no risk (GNRI: > 98) groups. The 5-year overall survival and independent prognostic factors were investigated, respectively. Results: A decreased GNRI significantly correlated with unfavorable overall survival (p < 0.001). In all patients, a multivariate analysis demonstrated that the severe and moderate risk groups (GNRI: < 92) (hazard ratio 0.50; p = 0.002), T factor (>= T2) (hazard ratio 0.52; p = 0.026), and N positive factor (hazard ratio 0.47; p = 0.004) were independent prognostic factors. In the subgroup analysis, which excluded patients with preoperative chemoradiotherapy, the severe and moderate risk groups (GNRI: < 92) (hazard ratio 0.48; p = 0.0057), and T factor (>= T2) (hazard ratio; p = 0.021) were independent prognostic factors. Conclusions: GNRI is considered to be a useful prognostic factor in patients with ESCC undergoing esophagectomy.