Impact of malnutrition on cancer recurrence, colorectal cancer-specific death, and non-colorectal cancer- related death in patients with colorectal cancer who underwent curative surgery

Purpose: The impact of malnutrition on colorectal cancer (CRC) recurrence and cause of death remains poorly understood. The present study aimed to examine how malnutrition, as reflected by the Geriatric Nutritional Risk Index (GNRI), is associated with CRC recurrence and cause of death. Methods: Subjects were 601 consecutive stage I-III CRC patients who underwent curative surgery between 2011 and 2017. We divided patients into two groups using GNRI 98 as the cut-off and evaluated the relationship of GNRI with overall survival (OS) and recurrence-free survival (RFS). Competing risk analysis was performed to determine prognostic factors of non-CRC-related death. Hazard functions were then used to examine changes in the risk of recurrence and death in each GNRI group over time. Results: The low GNRI group predicted significantly worse OS and RFS in multivariable analyses. Moreover, Fine-Gray model regression revealed that the low GNRI group was a significant predictor of non-CRC-related death. Hazard rate of recurrence and death in the low GNRI was approximately double that observed in the high GNRI group over 5 years; meanwhile, the hazard rate for recurrence in the low GNRI group was similar to that in the high GNRI group after 3 years. Meanwhile, the low GNRI group had a higher risk of non-CRC-related death over the course of 5 years. Conclusions: While preoperative malnutrition has a strong prognostic impact, its effect over time differs when endpoints are considered separately. These findings provide valuable information regarding healthcare prioritization during CRC survivorship.