Geriatric Nutritional Risk Index Predicting The Long-term Survival In Patients With Esophageal Squamous Cell Carcinoma Treated By Definitive Chemoradiotherapy

Objective:The aim of this study was to investigate the prognostic value of geriatric nutritional risk index(GNRI)in patients with esophageal squamous cell carcinoma(ESCC)treated by definitive chemoradiotherapy(d CRT).Methods:A retrospective study was performed on 202 ESCC patients who received d CRT in our hospital from 2013 to 2015.We collected the peripheral hematological indexes,and calculated GNRI and PNI.SPSS22.0software was used,analyzed progression-free survival(PFS)and Overall survival(OS)of patients by Kaplan-meier method.Furthermore,the prognostic value of the combined indexes of GNRI and N stage,GNRI and PNI were analyzed.Results:The followed-up ended on October 31,2020,and 9 cases were lost with the follow-up rate of 95.5%.In all patients,the median PFS and 1,3,5 year PFS rates were 17.41 months and 60.8%,29.4%and 24.1%,respectively.The median OS and 1,3,5 year OS rates were 20.30 months and74.1%,32.6%and 23.3%,respectively.According to the value of GNRI≥98or<98,202 patients of ESCC were divided into two groups of higher and lower GNRI.The median PFS and 1,3,5 year PFS rates in higher GNRI group were 21.95 months and 69.4%,35.2%,28.4%,respectively,and were9.66 months and 38.0%,11.5%,7.7%in lower GNRI group(χ~2=21.13,P<0.0001).The median OS and 1,3,5 year OS rates in higher GNRI group were27.96 months and 82.6%,42.0%,30.4%,respectively,and were 12.91 months and 52.7%,9.1%,5.5%in lower GNRI group(χ~2=35.32,P<0.0001).Cox proportional hazard model analysis showed that N stage,radiotherapy prescription dose and GNRI were independent prognostic factors of PFS and OS.The PFS and OS in higher GNRI group were still better than those in lower GNRI group after PSM(P=0.008,P=0.0004).The predictive capacity became stronger when the two parameters GNRI-N stage and GNRI-PNI in combination(AUROCs of GNRI、GNRI-N stage and GNRI-PNI=0.628,0.657,0.694).Conclusions:1.The geriatric nutritional risk index(GNRI)was the effectively predictive parameter for long-term survival of ESCC patients treated by d CRT.Patients had a better survival with higher value of GNRI.2.Co GNRI-N and co GNRI-PNI were also important indicators for predicting the survival of ESCC,and they had stronger predicting ability than GNRI alone,and had greater value for evaluating the clinical patients.3.There were several limitations that should be highlighted.Our results maybe inevitably interfered by the bias due to its retrospective quality and smaller number patients from our single institution.