Significance of geriatric nutritional risk index and neutrophil-to-lymphocyte ratio as prognostic indicators in older patients with gastric cancer: A retrospective cohort study

Abstract Background: The number of older patients with cancer is increasing with the progression of aging societies. We aimed to clarify the prognostic values of the geriatric nutritional risk index (GNRI) as a nutritional index and the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory index in older patients with gastric cancer. Methods: Between January 2007 and December 2016, a total of 197 consecutive gastric cancer patients aged ≥75 years who underwent radical gastrectomy were included in this study. We evaluated the prognostic values of preoperative GNRI and NLR using time-dependent receiver operating characteristic curveanalysis, log-rank tests and Cox regression analysis. Results: The areas under the curve (AUCs) predicting 5-year OS were 0.668 for GNRI and 0.637 for NLR. The 5-year OS rates in the groups with low and high GNRI and NLR were 40.1% and 74.1% (p<0.001), 70.7% and 41.5% (p<0.001), respectively. Multivariate analysis showed that GNRI (Hazard ratio (HR): 0.584; 95% confidence interval (CI): 0.356–0.960; p=0.034) and NLR (HR: 2.470; 95% CI: 1.503–4.059; p<0.001) were independent predictors for OS. GNRI-NLR score constructed with GNRI and NLR had a higher AUC of 0.698 than those of either GNRI or NLR alone, and was an independent prognostic factor (HR, 0.486; 95% CI: 0.363–0.651; p<0.001). Conclusions: GNRI and NLR are useful prognostic biomarkers in older gastric cancer patients aged ³75years, and the GNRI-NLR score could contribute to a more personalized and holistic approach to cancer treatment in older gastric cancer patients.