The Geriatric Nutritional Risk Index as a Prognosis Predictor in Patients With Rectal Cancer Receiving Neoadjuvant Chemotherapy

There are few reports on the clinical significance of the geriatric nutritional risk index (GNRI) in patients with locally advanced rectal cancer who undergo preoperative chemotherapy (NAC, neoadjuvant chemotherapy) followed by radical resection; this study examined the relationship between preoperative GNRI, postoperative complications, and prognosis in these patients.Fifty-seven patients with rectal cancer who underwent radical resection after NAC at Osaka University Hospital between November 2011 and May 2018 were included. The GNRI was calculated as follows: GNRI= [1.489×serum albumin level (g/l)]+[41.7×present/ideal body weight (kg)]. Patients were classified into high (GNRI ≥96.74; n=36) and low GNRI (GNRI <96.74; n=21) groups, based on the results of the receiver operating characteristic curve analysis.The Kaplan-Meier analysis showed that the low GNRI group had a significantly poorer cancer-specific survival (CSS) and a poorer overall survival tendency than the high GNRI group. In the univariate analysis, venous invasion, lymphatic vessel invasion, and low GNRI were significantly correlated with CSS; depth of tumor invasion, lymph node metastasis, and lymphatic vessel invasion were significantly correlated with disease-free survival (DFS). In the multivariate analysis, there were no significantly poor prognostic factors for CSS and DFS.Preoperative GNRI may be a useful predictor for recurrence and poor prognosis in elderly patients with rectal cancer who undergo radical resection after NAC. Further studies and accumulation of cases should investigate the relationship between preoperative GNRI and prognosis after NAC in elderly patients.