Abstract:
To evaluate the prognostic value of the geriatric nutritional risk index (GNRI) in patients with esophageal squamous cell carcinoma (ESCC) treated with definitive chemoradiotherapy (dCRT).
Methods A total of 202 ESCC patients treated with definitive chemoradiotherapy in The Fourth Hospital of Hebei Medical University from January 2013 to December 2015 were recruited. GNRI and prognostic nutritional index (PNI) were calculated before treatment, and the patients were assigned into the higher GNRI group (GNRI ≥ 98) and lower GNRI group (GNRI < 98). The effects of GNRI on progression-free survival (PFS) and overall survival (OS) were retrospectively analyzed. The nomogram for survival prediction was established using R software. The accuracy of prediction of the nomogram was evaluated using the C-index and calibration curve. The prognostic value of combined GNRI and N stage, GNRI, and PNI was further analyzed.
Results Of the 202 patients, 145 patients (71.8%) were in the higher GNRI group and 57 patients (28.2%) were in the lower GNRI group. Multivariate analysis showed that N stage, radiotherapy prescription dose, and GNRI were independent prognostic factors of PFS and OS. A nomogram for PFS and OS was generated using the significant characteristics in the multivariate analysis. C-index was 0.663 and 0.656, respectively. The calibration plots presented a good agreement between the nomogram prediction and actual observation for 1-, 3-, and 5-year PFS and OS. The predictive capacity became stronger when the two parameters GNRI-N stage and GNRI-PNI were used in combination (AUROCs of GNRI, GNRI-N stage, and GNRI-PNI was 0.628, 0.657, and 0.694, respectively).
Conclusions GNRI can be used as a new simple and effective indicator for predicting survival in ESCC patients treated with definitive chemoradiotherapy. The combination of GNRI and N stage, GNRI, and PNI can enhance the accuracy of prognosis prediction.
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