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. 2023 Jan 13;13(1):155.
doi: 10.3390/jpm13010155.

The Prognostic Value of the GNRI in Patients with Stomach Cancer Undergoing Surgery

Qianqian Zhang  1 , Lilong Zhang  2   3 , Qi Jin  4 , Yongheng He  5 , Mingsheng Wu  5 , Hongxing Peng  1 , Yijin Li  5
Affiliations

The Prognostic Value of the GNRI in Patients with Stomach Cancer Undergoing Surgery

Qianqian Zhang et al. J Pers Med. .

Abstract

Malnutrition often induces an adverse prognosis in cancer surgery patients. The elderly nutrition risk index (GNRI) is an example of the objective indicators of nutrition-related risks. We performed a meta-analysis to thoroughly examine the evidence for the GNRI in predicting the outcomes of patients undergoing stomach cancer surgery. Eligible articles were retrieved using PubMed, the Cochrane Library, EMBASE, and Google Scholar by 24 October 2022. The clinical outcomes were overall survival (OS), cancer-specific survival (CSS), and post-operative complications. A total of 11 articles with 5593 patients were included in this meta-analysis. The combined forest plot showed that for every unit increase in the preoperative GNRI score in patients with stomach cancer, their postoperative mortality was reduced by 5.6% (HR: 0.944; 95% CI: 0.933−0.956, p < 0.001). The pooled results also demonstrated that a low GNRI was correlated with poor OS (HR: 2.052; 95% CI: 1.726−2.440, p < 0.001) and CSS (HR: 1.684; 95% CI: 1.249−2.270, p = 0.001) in patients who underwent stomach cancer surgery. Postoperative complications were more likely to occur in patients with a low GNRI, as opposed to those with a high GNRI (OR: 1.768; 95% CI: 1.445−2.163, p < 0.001). There was no evidence of significant heterogeneity, and the sensitivity analysis supported the stability and dependability of the above results. the GNRI is a valuable predictor of long-term outcomes and complications in stomach cancer patients undergoing surgery.

Keywords: geriatric nutritional risk index; meta-analysis; prognosis; stomach cancer; surgery.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
The flow diagram of identifying eligible studies.
Figure 2
Figure 2
Meta-analysis of overall survival. Forest plot of the GNRI (dichotomous variable) in relation to overall survival (A). Forest plot of GNRI (continuous variable) in relation to overall survival (B). HR, hazard ratio; CL, confidence interval; GNRI, geriatric nutrition risk index [13,14,15,16,17,18,19,20,21].
Figure 3
Figure 3
Forest plot of the GNRI in relation to cancer-specific survival (A) and postoperative complications (B). HR, hazard ratio; OR, odds ratio; CL, confidence interval; GNRI, geriatric nutrition risk index [14,16,17,19,20,21,22,23].
Figure 4
Figure 4
Subgroup analysis of overall survival based on sample size (A), cut-off value (B), treatment (C), and publishing year (D). ESD, endoscopic submucosal dissection; HR, hazard ratio; CL, confidence interval [14,16,17,18,19,20,21].
Figure 5
Figure 5
Subgroup analysis of postoperative complications based on sample size (A), cut-off value (B), treatment (C), and publishing year (D). ESD, endoscopic submucosal dissection; OR, odds ratio; CL, confidence interval [14,16,17,18,19,20,21].
Figure 6
Figure 6
Sensitivity analysis of overall survival (A) and postoperative complications (B). CL, confidence interval [14,16,17,19,20,21].
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