The prognostic value of the Geriatric Nutritional Risk Index (GNRI) significantly predicts cancer-specific survival outcomes for patients with upper tract urothelial carcinoma after radical nephroureterectomy.
A study conducted at West China Hospital has revealed the importance of the Geriatric Nutritional Risk Index (GNRI) as a predictor of cancer-specific survival (CSS) for patients suffering from upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). With UTUC being one of the most challenging forms of cancer due to its typically poor prognosis, the findings shed light on the relationship between nutritional assessment and patient survival outcomes.
UTUC, which is responsible for only 5%-10% of all urothelial carcinomas, originates from the renal pelvis and ureter and presents significant treatment challenges. The current mainstay for treatment is radical nephroureterectomy, followed by additional interventions aiming to improve patient outcomes. The exploration of nutritional interventions has gained traction, as studies suggest nutritional status can considerably impact cancer recovery and overall survival.
The retrospective study included 219 patients who had undergone RNU from May 2016 to June 2019. The primary aim was to determine the prognostic role of the GNRI, which takes body weight, height, and serum albumin levels to evaluate malnutrition risk and overall health. The analysis revealed significant discrepancies based on GNRI levels, with higher GNRI indices correlatively linked to improved CSS. Specifically, those with higher GNRI displayed statistically significantly elevated CSS rates (hazard ratio = 0.58; 95% confidence interval, 0.32–0.92; P = 0.037).
Utilizing advanced statistical analysis, the authors established the optimal GNRI cut-off values at 91.2 and 98.8, identifying three groups of patients: low-GNRI (14.61%), medium-GNRI (22.83%), and high-GNRI (62.56%). Kaplan–Meier plots indicated patients within the high-GNRI group had significantly lower chances of cancer-specific mortality compared to their low-GNRI counterparts (P = 0.024). Through multivariate analysis, it was noted the GNRI served as an independent predictor for CSS among other notable factors such as tumor location, stage, grade, and surgical margins.
The study introduced a nomogram based on the GNRI alongside these clinical factors, demonstrating high predictive accuracy for 2-year and 4-year CSS, reinforcing the potential of integrating nutritional factors for patient prognosis. The nomogram achieved areas under the curve (AUC) of 0.810 and 0.842, respectively, signifying its strong performance compared to conventional models.
Reflecting on the study, the authors stated: “Preoperative GNRI is an independent predictor for CSS in UTUC patients who underwent RNU and should be considered as a promising personalized tool for clinical decision-making.” This predictive approach not only holds promise for UTUC patients but highlights the broader applicability of GNRI across various cancers and conditions, taking important strides toward personalized treatment strategies.
While the study has taken significant steps to elucidate the importance of nutritional assessment, it also has its limitations. The findings are based on retrospective data from a single institution, which may limit its generalizability. The authors note the need for external validation of the nomogram and greater exploration of how dietary interventions might contribute to improved survival rates.
Overall, this research emphasizes the integrative role of nutrition within cancer treatment protocols, encouraging future investigations on nutritional support as a means of enhancing clinical outcomes for patients with upper tract urothelial carcinoma post-surgery.