Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 27:12:1587824.
doi: 10.3389/fnut.2025.1587824. eCollection 2025.

The joint role of systemic immune-inflammation index and geriatric nutritional risk index in cancer survivors and their impact on all-cause mortality

Xiangrui Chen #  1   2 , Min Hu #  3 , Chengluo Hao  2 , Jun Li  2 , Yunwei Han  1
Affiliations

The joint role of systemic immune-inflammation index and geriatric nutritional risk index in cancer survivors and their impact on all-cause mortality

Xiangrui Chen et al. Front Nutr. .

Abstract

Introduction: This study aimed to investigate the combined predictive value of the Systemic Immune-Inflammation Index (SII) and the Geriatric Nutritional Risk Index (GNRI) for all-cause mortality in cancer survivors.

Methods: Using NHANES data (1999-2018), 2,969 eligible cancer survivors were categorized into four groups based on SII and GNRI levels. Mortality risk was assessed through unadjusted and fully adjusted Cox proportional hazards models.

Results: The combination of low SII and high GNRI was associated with the lowest mortality risk (HR = 1.0, reference). In contrast, high SII and low GNRI significantly increased mortality risk (fully adjusted HR = 6.178, 95% CI: 2.669-14.299). Both unadjusted and adjusted models confirmed that high SII correlated with higher mortality, while low GNRI independently predicted poorer outcomes. Subgroup analyses revealed significant interactions between the SII-GNRI combination and gender/alcohol consumption.

Discussion: The findings highlight SII and GNRI as critical predictors of all-cause mortality in cancer survivors. Their combined assessment may improve risk stratification and guide targeted clinical interventions.

Keywords: Dietary Inflammatory Index; NHANES; all-cause mortality; cancer survivors; geriatric nutritional risk index; systemic immune-inflammation index.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Flowchart of participant selection from NHANES 1999-2018: starts with 101,316 individuals interviewed. Excludes 96,127 without cancer data, 651 with missing SII data, and 1,596 with missing GNRI data. Final inclusion is 2,969 cancer survivors.
FIGURE 1
Flowchart of participant selection.
Graphs A and C depict an inverse relationship between GNRI and mortality rates. Graphs B and D show a non-linear relationship between SII and mortality rates. Both sets include confidence intervals.
FIGURE 2
Comparative Dose-Response analysis of GNRI and SII as prognostic biomarkers for post-cancer survival. (A) (GNRI vs all-cause mortality): Linear decrease in risk with higher GNRI (HR 0.82 per 1-unit increase, 95% CI 0.79–0.85). (B) (SII vs all-cause mortality): Risk rises sharply when SII >3,000 cells/μL. (C) (GNRI vs cancer mortality): Consistent protective effect (HR 0.89, 95% CI 0.84–0.94). (D) (SII vs cancer mortality): Biphasic pattern: neutral (<1,500 cells/μL), modest risk (1,500–3,000 cells/μL; HR 1.12), high risk (>3,000 cells/μL; HR 1.58).
Bar chart showing Odds Ratio (OR) for High-GNRI, Low-GNRI, High-SII, and Low-SII categories with three adjustments: Adjust I (green), Adjust II (blue), and Non-adjusted (orange). High-SII bars have the highest odds ratio, with significant error bars. Low-GNRI has the smallest OR.
FIGURE 3
Odds ratios (OR) for different GNRI and SII levels with various adjustments.
Forest plot showing odds ratios. Four categories are listed: Low-SII and High-GRNI, High-SII and High-GRNI, Low-SII and Low-GRNI, High-SII and Low-GRNI. Each has a horizontal line with a blue square marker indicating the odds ratio. High-SII and Low-GRNI category extends beyond 20 on the odds ratio scale, indicating higher odds compared to others.
FIGURE 4
Forest plot of odds ratios (OR) for different SII and GNRI combinations.
See this image and copyright information in PMC

References

    1. Siegel R, Miller K, Fuchs H, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. (2021) 71:7–33. 10.3322/caac.21654 - DOI - PubMed
    1. Qiu X, Wu Q, Zhang Y, Zhu Y, Yang M, Tao L. Geriatric nutritional risk index and mortality from all-cause, cancer, and non-cancer in US cancer survivors: nhanes 2001-2018. Front Oncol. (2024) 14:1399957. 10.3389/fonc.2024.1399957 - DOI - PMC - PubMed
    1. Wu S, Liu Z, Li X, Gao S, Xia P. Association between systemic immune-inflammation index and the risk of all-cause, cancer and non-cancer mortality in the general population: Results from national health and nutrition examination survey 2005-2018. BMC Public Health. (2025) 25:227. 10.1186/s12889-025-21423-1 - DOI - PMC - PubMed
    1. Li W, Wang X, Diao H, Yang Y, Ding L, Huan W, et al. Systemic immune inflammation index with all-cause and cause-specific mortality: A meta-analysis. Inflamm Res. (2024) 73:2199–216. 10.1007/s00011-024-01959-5 - DOI - PubMed
    1. Baughman C, Norman K, Mukamal K. Adherence to American cancer society nutrition and physical activity guidelines among cancer survivors. JAMA Oncol. (2024) 10:789–92. 10.1001/jamaoncol.2024.0470 - DOI - PMC - PubMed

LinkOut - more resources