Geriatric nutritional risk index as a prognostic marker of pTNM-stage I and II esophageal squamous cell carcinoma after curative resection
Noriyuki Hirahara, Takeshi Matsubara, Yusuke Fujii, Shunsuke Kaji, Ryoji Hyakudomi, Tetsu Yamamoto, Yuki Uchida, Yoshiko Miyazaki, Kazunari Ishitobi, Yasunari Kawabata, Yoshitsugu Tajima
Abstract
// Noriyuki Hirahara 1 , Takeshi Matsubara 1 , Yusuke Fujii 1 , Shunsuke Kaji 1 , Ryoji Hyakudomi 1 , Tetsu Yamamoto 1 , Yuki Uchida 1 , Yoshiko Miyazaki 1 , Kazunari Ishitobi 1 , Yasunari Kawabata 1 and Yoshitsugu Tajima 1 1 Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan Correspondence to: Noriyuki Hirahara, email: [email protected] Keywords: geriatric nutritional risk index; esophageal squamous cell carcinoma; curative esophagectomy; cancer-specific survival; pathological tumor-node-metastasis Received: May 09, 2020     Accepted: June 20, 2020     Published: July 21, 2020 ABSTRACT The geriatric nutritional risk index (GNRI) is associated with mortality in several malignancies. We retrospectively analyzed whether the GNRI can predict long-term outcomes in 191 patients with esophageal squamous cell carcinoma (ESCC) after curative esophagectomies by evaluating their cancer-specific survival (CSS). In multivariate analyses, serum albumin (hazard ratio [HR], 2.498; p = 0.0043), GNRI (HR, 1.941; p = 0.0181), pathological tumor-node-metastasis (pTNM) stage (HR, 3.884; p < 0.0001), and tumor differentiation (HR, 2.307; p = 0.0066) were independent prognostic factors for CSS. In pTNM stage I, multivariate analysis identified C-reactive protein (HR, 7.172; p = 0.0483) and GNRI (HR, 5.579; p = 0.0291) as independent prognostic factors for CSS. In univariate analyses in pTNM stages II and III, only low GNRI ( p = 0.0095) and low serum albumin levels ( p = 0.0119), respectively, were significantly associated with worse CSS. In patients with low GNRI, CSS was significantly worse than in those with normal GNRI ( p = 0.0011), especially in pTNM stages I ( p = 0.0044) and II ( p = 0.0036) groups, but not in stage III group ( p = 0.5099). Preoperative GNRI may sort patients into low- or high-risk groups for shorter CSS, especially in those with pTNM stage I and II ESCC.