Geriatric Nutritional Index Influences Survival Outcomes in Gastric Carcinoma Patients Undergoing Radical Surgery.

BACKGROUND The survival impact of the geriatric nutritional risk index (GNRI) has yet to be investigated in patients undergoing gastric carcinoma (GC) surgery. METHODS In total, 1166 GC patients who underwent radical gastrectomy were retrospectively reviewed. The predictive and discrimination abilities for overall survival (OS) were compared among GNRI, prognostic nutritional index (PNI) and systemic inflammatory markers employing receiver operating characteristic analysis and Harrell's C-statistics. Patients were dichotomized according to GNRI (GNRI <98; low, GNRI ≥98; high) and the impacts of GNRI on OS and cancer-specific survival (CSS) were evaluated using multivariate Cox hazards analysis. RESULTS GNRI showed superior discrimination and predictive ability for OS as compared to other indices examined in this study. There were 447 (38.3%) and 719 (61.7%) patients in the low- and high-GNRI groups, respectively. Patients with low GNRI were older, had more comorbidities and a higher pStage III disease rate than those with high GNRI (all P < 0.001). OS curves were significantly stratified by GNRI in all patients (P < 0.001) and those with pStage I (P < 0.001), II (P < 0.001) and III (P = 0.02) disease. Multivariate analysis showed low GNRI to be independently associated with poor OS (HR 2.15, 95% CI 1.61-2.87, P < 0.001). Furthermore, low GNRI was an independent predictor of poor CSS (HR 1.61, 95% CI 1.07-2.44, P = 0.02) as were total gastrectomy (P < 0.001) and pStage III disease (P < 0.001). Patients who had low GNRI and underwent total gastrectomy showed quite poor 5-year OS (54.8%). CONCLUSION GNRI is useful for predicting survival and oncological outcomes in GC patients. This article is protected by copyright. All rights reserved.