Geriatric Nutritional Risk Index as a Prognostic Factor of Patients with Non-Small Cell Lung Cancer: A Meta-Analysis

Abstract

Geriatric nutritional risk index (GNRI), a newly developed indicator of nutritional status retrieved by serum albumin concentration and ideal body weight, has been suggested as a prognostic factor for various malignancies. The aim of the study was to summarize the prognostic role of GNRI for patients with non-small cell lung cancer (NSCLC) in a meta-analysis. Cohort studies evaluating the relationship between GNRI at baseline and survival OF NSCLC were retrieved by search of PubMed, Embase, and Web of Science databases from inception to January 12, 2022. A conservative random-effect model incorporating the possible influence of between-study heterogeneity was used to pool the results. Eleven cohorts including 2865 patients with NSCLC were included. Compared to those with higher GNRI, NSCLC patients with lower GNRI were associated with poorer overall survival [OS, hazard ratio (HR): 2.39, 95% CI: 1.97–2.91, p<0.001; I2=29%), progression-free survival (HR: 1.94, 95% CI: 1.52–2.47, p<0.001; I2=29%), and cancer-specific survival (HR: 2.59, 95% CI: 1.55–4.35, p<0.001; I2=0%). Subgroup analyses showed that the significant association between lower GNRI and worse OS in patients with NSCLC was not affected by study characteristics including study location, design, cancer stage, treatment, or follow-up durations (p for subgroup effects all<0.001). In conclusion, a lower GNRI in patients with NSCLC may be a predictor of poor survival. Nutritional status indicated by GNRI may be important for the prognostic prediction of patients with NSCLC.

Key words

geriatric nutritional risk index - non-small cell lung cancer - survival - predict - meta-analysis

Publication History

Received: 15 May 2022

Accepted after revision: 11 July 2022

Article published online:
07 September 2022

• References

• 1 Xia C, Dong X, Li H. et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J (Engl) 2022; 135: 584-590
• 2 Siegel RL, Miller KD, Fuchs HE. et al. Cancer statistics, 2022. CA Cancer J Clin 2022; 72: 7-33
• 3 Ettinger DS, Wood DE, Aisner DL. et al. NCCN guidelines insights: non-small cell lung cancer, version 2.2021. J Natl Compr Canc Netw 2021; 19: 254-266
• 4 Hanna NH, Robinson AG, Temin S. et al. Therapy for stage IV non-small-cell lung cancer with driver alterations: ASCO and OH (CCO) joint guideline update. J Clin Oncol 2021; 39: 1040-1091
• 5 Mantzorou M, Koutelidakis A, Theocharis S. et al. Clinical value of nutritional status in cancer: what is its impact and how it affects disease progression and prognosis?. Nutr Cancer 2017; 69: 1151-1176
• 6 Ravasco P.. Nutrition in cancer patients. J Clin Med 2019; 8: 1211
• 7 Hamaker ME, Oosterlaan F, van Huis LH. et al. Nutritional status and interventions for patients with cancer – a systematic review. J Geriatr Oncol 2021; 12: 6-21
• 8 Baldessari C, Guaitoli G, Valoriani F. et al. Impact of body composition, nutritional and inflammatory status on outcome of non-small cell lung cancer patients treated with immunotherapy. Clin Nutr ESPEN 2021; 43: 64-75
• 9 Bossi P, Delrio P, Mascheroni A. et al. The spectrum of malnutrition/cachexia/sarcopenia in oncology according to different cancer types and settings: a narrative review. Nutrients 2021; 13: 1980
• 10 Bouillanne O, Morineau G, Dupont C. et al. Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 2005; 82: 777-783
• 11 Kalantar-Zadeh K, Kopple JD, Block G. et al. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis 2001; 38: 1251-1263
• 12 Chen W, Fong JW, Lind CR. et al. P-POSSUM scoring system for mortality prediction in general neurosurgery. J Clin Neurosci 2010; 17: 567-570
• 13 Steiber AL, Kalantar-Zadeh K, Secker D. et al. Subjective global assessment in chronic kidney disease: a review. J Ren Nutr 2004; 14: 191-200
• 14 Duran Alert P, Mila Villarroel R, Formiga F. et al. Assessing risk screening methods of malnutrition in geriatric patients: mini nutritional assessment (MNA) versus geriatric nutritional risk index (GNRI). Nutr Hosp 2012; 27: 590-598
• 15 Leandro-Merhi VA, de Aquino JLB, Reis LO. Predictors of nutritional risk according to NRS-2002 and calf circumference in hospitalized older adults with neoplasms. Nutr Cancer 2017; 69: 1219-1226
• 16 Fan H, Ma W, Fu Y. et al. Association of geriatric nutritional risk index with survival outcomes in patients with esophageal squamous cell carcinoma: a meta-analysis. Nutr Cancer 2022; 1-7
• 17 Tang Y, Liang J, Liu Z. et al. Clinical significance of prognostic nutritional index in renal cell carcinomas. Medicine (Baltimore) 2021; 100: e25127
• 18 Page MJ, Moher D, Bossuyt PM. et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021; 372: n160
• 19 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
• 20 Higgins J, Thomas J, Chandler J. et al. Cochrane handbook for systematic reviews of interventions version 6.2. The Cochrane Collaboration. 2021 www.training.cochrane.org/handbook
• 21 Miura N, Mori K, Mostafaei H. et al. The prognostic impact of intraductal carcinoma of the prostate: a systematic review and meta-analysis. J Urol 2020; 204: 909-917
• 22 Templeton AJ, McNamara MG, Seruga B. et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst 2014; 106 dju124
• 23 Wells GA, Shea B, O’Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2010 http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
• 24 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539-1558
• 25 Patsopoulos NA, Evangelou E, Ioannidis JP. Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol 2008; 37: 1148-1157
• 26 Egger M, Davey Smith G, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
• 27 Shoji F, Matsubara T, Kozuma Y. et al. Preoperative geriatric nutritional risk index: a predictive and prognostic factor in patients with pathological stage I non-small cell lung cancer. Surg Oncol 2017; 26: 483-488
• 28 Shoji F, Miura N, Matsubara T. et al. Prognostic significance of immune-nutritional parameters for surgically resected elderly lung cancer patients: a multicentre retrospective study. Interact Cardiovasc Thorac Surg 2017; 26: 389-394
• 29 Hino H, Saito T, Matsui H. et al. Utility of geriatric nutritional risk index in patients with lung cancer undergoing surgery. Eur J Cardiothorac Surg 2020; 58: 775-782
• 30 Asakawa A, Ishibashi H, Matsuyama Y. et al. Preoperative nutritional status is associated with the prognosis for lung cancer. Asian Cardiovasc Thorac Ann 2021; 29: 763-771
• 31 Karayama M, Inoue Y, Yasui H. et al. Association of the geriatric nutritional risk index with the survival of patients with non-small-cell lung cancer after platinum-based chemotherapy. BMC Pulm Med 2021; 21: 409
• 32 Matsuura S, Morikawa K, Ito Y. et al. The geriatric nutritional risk index and prognostic nutritional index predict the overall survival of advanced non-small cell lung cancer patients. Nutr Cancer 2021; 1-8
• 33 Peng SM, Yu N, Ren JJ. et al. The geriatric nutritional risk index as a prognostic factor in patients with advanced non-small-cell lung cancer. Nutr Cancer 2021; 73: 2832-2841
• 34 Sonehara K, Tateishi K, Araki T. et al. Prognostic value of the geriatric nutritional risk index among patients with previously treated advanced non-small cell lung cancer who subsequently underwent immunotherapy. Thorac Cancer 2021; 12: 1366-1372
• 35 Takahashi M, Sowa T, Tokumasu H. et al. Comparison of three nutritional scoring systems for outcomes after complete resection of non-small cell lung cancer. J Thorac Cardiovasc Surg 2021; 162: 1257-1268 e1253
• 36 Tang M, Li L, Zhang P. et al. The geriatric nutritional risk index predicts overall survival in geriatric patients with metastatic lung adenocarcinoma. Nutr Cancer 2021; 1-9
• 37 Karayama M, Inoue Y, Yoshimura K. et al. Association of the geriatric nutritional risk index with the survival of patients with non-small cell lung cancer after nivolumab therapy. J Immunother 2022; 45: 125-131
• 38 Akimoto T, Hara M, Morita A. et al. Relationship between nutritional scales and prognosis in elderly patients after acute ischemic stroke: comparison of controlling nutritional status score and geriatric nutritional risk index. Ann Nutr Metab 2021; 77: 116-123
• 39 Li H, Cen K, Sun W. et al. Prognostic value of geriatric nutritional risk index in elderly patients with heart failure: a meta-analysis. Aging Clin Exp Res 2021; 33: 1477-1486
• 40 Shi X, Shen Y, Yang J. et al. The relationship of the geriatric nutritional risk index to mortality and length of stay in elderly patients with acute respiratory failure: a retrospective cohort study. Heart Lung 2021; 50: 898-905
• 41 Jia Z, El Moheb M, Nordestgaard A. et al. The geriatric nutritional risk index is a powerful predictor of adverse outcome in the elderly emergency surgery patient. J Trauma Acute Care Surg 2020; 89: 397-404
• 42 Lv GY, An L, Sun DW. Geriatric nutritional risk index predicts adverse outcomes in human malignancy: a meta-analysis. Dis Markers 2019; 4796598
• 43 Wang H, Li C, Yang R. et al. Prognostic value of the geriatric nutritional risk index in non-small cell lung cancer patients: a systematic review and meta-analysis. Front Oncol 2021; 11: 794862
• 44 Wang Y, Luo L, Li J. et al. Prognostic value of pretreatment geriatric nutrition risk index in lung cancer patients: a meta-analysis. Nutr Cancer 2022; 1-8
• 45 Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J 2010; 9: 69
• 46 Gupta A, Majumder K, Arora N. et al. Premorbid body mass index and mortality in patients with lung cancer: a systematic review and meta-analysis. Lung Cancer 2016; 102: 49-59
• 47 Sun L, Yin H, Liu M. et al. Impaired albumin function: a novel potential indicator for liver function damage?. Ann Med 2019; 51: 333-344
• 48 Sleep D. Albumin and its application in drug delivery. Expert Opin Drug Deliv 2015; 12: 793-812
• 49 Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial 2004; 17: 432-437
• 50 Wilde B, Katsounas A. Immune dysfunction and albumin-related immunity in liver cirrhosis. Mediators Inflamm 2019; 7537649
• 51 Tabata F, Wada Y, Kawakami S. et al. Serum albumin redox states: more than oxidative stress biomarker. Antioxidants (Basel) 2021; 10: 503
• 52 Anderson AS, Martin RM, Renehan AG. et al. Cancer survivorship, excess body fatness and weight-loss intervention-where are we in 2020?. Br J Cancer 2021; 124: 1057-1065
• 53 Arends J, Baracos V, Bertz H. et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr 2017; 36: 1187-1196
• 54 Hebuterne X, Lemarie E, Michallet M. et al. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enteral Nutr 2014; 38: 196-204
• 55 Barreira JV. The role of nutrition in cancer patients. Nutr Cancer 2021; 73: 2849-2850