The Geriatric Nutritional Risk Index as a Prognostic Factor in Patients with Advanced Non-Small-Cell Lung Cancer

Abstract

The Geriatric Nutritional Risk Index (GNRI) is widely applied as a prognostic factor in different cancers. We aimed to analyze the prognostic value of the GNRI in 257 patients diagnosed with advanced non-small-cell lung cancer (NSCLC). Patients with GNRI >98, 92–98, and <92 were grouped into normal, low risk and moderate/high risk groups, respectively. There were 45.1% patients at risk for malnutrition. Kaplan-Meier survival curves indicated that patients with lower GNRI scores had a poorer overall survival (OS). Two-year OS for normal, low risk and moderate/high risk groups were 57.4%, 42.3% and 15.8%, respectively. In multivariate survival analysis, GNRI (<92), body mass index (BMI, ≥24 kg/m2), combined therapy, hemoglobin and neutrophil-to-lymphocyte ratio (NLR) were independent prognostic factors of OS. Stratifying by age groups, GNRI (<92), hemoglobin and NLR were independent prognostic factors of OS in patients aged <65 years. GNRI (<92), smoking, BMI (≥24 kg/m2) and platelet-to-lymphocyte ratio were independent prognostic factors of OS in patients aged ≥65 years. In conclusion, GNRI was a significant prognostic factor in advanced NSCLC patients regardless of age. A decreased GNRI may be considered as a clinical trigger for nutritional support in advanced NSCLC patients, though additional studies are still required to confirm the best cut-point.

Acknowledgments

The authors would like to thank the health care workers of the first affiliated hospital and the second affiliated hospital of Soochow University for information collection and processing. We thank all the patients of the Soochow Lung Cancer Cohort for their contributions to this study.

Author Contributions

Qin L.Q., Xu J.Y. and Chen G.C. conceived and designed the study. Peng S.M. and Qin L.Q. wrote the manuscript. Peng S.M. and Yu N. performed the statistical analysis. Li Z.N. and Du H.Z. coordinated the research. Peng S.M., Yu N., Ren J.J. and Yang J.R. conducted questionnaire survey and sample collection. Li D.P. and Zhang Y.S. organized the questionnaire and sample information. All authors read and approved the final manuscript.

Conflict of Interest

The authors declare no potential conflicts of interest.

Funding

This work was supported by the National Natural Science Foundation of China (No. 81472974, 81,673,101) and the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD).