Skip to main content
Top

23-04-2024 | Gastric Cancer | Original Article

Using the geriatric nutritional risk index to predict outcomes in older patients with remnant gastric cancer after gastrectomy: a retrospective multicenter study in Japan

Authors: Tomoyuki Matsunaga, Hiroaki Saito, Tomohiro Osaki, Kenji Fukuda, Yoji Fukumoto, Sadamu Takahashi, Kenjiro Taniguchi, Akemi Iwamoto, Hirohiko Kuroda, Kuniyuki Katano, Shota Shimizu, Yuji Shishido, Kozo Miyatani, Teruhisa Sakamoto, Yoshiyuki Fujiwara

Published in: Surgery Today

Login to get access

Abstract

Purpose

This study investigated the prognostic value of the geriatric nutritional risk index (GNRI) in patients undergoing curative gastrectomy for remnant gastric cancer (RGC).

Methods

This multicenter retrospective study included 105 patients with RGC of ≥ 65 years of age who underwent curative gastrectomy at 10 institutions in Japan between January 2000 and December 2016. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) were analyzed.

Results

Receiver operating curve analyses indicated that the optimal cutoff value of the GNRI for OS was 95.4. Patients were categorized into high and low GNRI groups based on the optimal GNRI cutoff value. The GNRI was significantly correlated with body mass index (p < 0.001), amount of bleeding (p = 0.021), Clavien–Dindo grade 5 postoperative complications (p = 0.040), death caused by primary disease (p = 0.010), and death caused by other diseases (p = 0.002). The OS and DSS were significantly worse in the low GNRI group. A low GNRI and T3 or deeper tumor invasion were independent prognostic factors for OS and DSS.

Conclusions

The GNRI is a promising predictor of both short- and long-term outcomes in older patients with RGC.
Appendix
Available only for authorised users
Literature
1.
go back to reference Inomata M, Shiraishi N, Adachi Y, Yasuda K, Aramaki M, Kitano S. Gastric remnant cancer compared with primary proximal gastric cancer. Hepatogastroenterol. 2003;50:587–91. Inomata M, Shiraishi N, Adachi Y, Yasuda K, Aramaki M, Kitano S. Gastric remnant cancer compared with primary proximal gastric cancer. Hepatogastroenterol. 2003;50:587–91.
2.
go back to reference Kodera Y, Yamamura Y, Torii A, Uesaka K, Hirai T, Yasui K, et al. Incidence, diagnosis and significance of multiple gastric cancer. Br J Surg. 1995;82:1540–3.CrossRefPubMed Kodera Y, Yamamura Y, Torii A, Uesaka K, Hirai T, Yasui K, et al. Incidence, diagnosis and significance of multiple gastric cancer. Br J Surg. 1995;82:1540–3.CrossRefPubMed
3.
go back to reference Ohashi M, Katai H, Fukagawa T, Gotoda T, Sano T, Sasako M. Cancer of the gastric stump following distal gastrectomy for cancer. Br J Surg. 2007;94:92–5.CrossRefPubMed Ohashi M, Katai H, Fukagawa T, Gotoda T, Sano T, Sasako M. Cancer of the gastric stump following distal gastrectomy for cancer. Br J Surg. 2007;94:92–5.CrossRefPubMed
4.
go back to reference Yokota T, Ishiyama S, Saito T, Teshima S, Narushima Y, Murata K, et al. Lymph node metastasis as a significant prognostic factor in gastric cancer: a multiple logistic regression analysis. Scand J Gastroenterol. 2004;39:380–4.CrossRefPubMed Yokota T, Ishiyama S, Saito T, Teshima S, Narushima Y, Murata K, et al. Lymph node metastasis as a significant prognostic factor in gastric cancer: a multiple logistic regression analysis. Scand J Gastroenterol. 2004;39:380–4.CrossRefPubMed
5.
go back to reference Yamashita K, Hosoda K, Ema A, Watanabe M. Lymph node ratio as a novel and simple prognostic factor in advanced gastric cancer. Eur J Surg Oncol. 2016;42:1253–60.CrossRefPubMed Yamashita K, Hosoda K, Ema A, Watanabe M. Lymph node ratio as a novel and simple prognostic factor in advanced gastric cancer. Eur J Surg Oncol. 2016;42:1253–60.CrossRefPubMed
6.
go back to reference Lin JX, Lin JP, Xie JW, Wang JB, Lu J, Chen QY, et al. Prognostic importance of the preoperative modified systemic inflammation score for patients with gastric cancer. Gastric Cancer. 2019;22:403–12.CrossRefPubMed Lin JX, Lin JP, Xie JW, Wang JB, Lu J, Chen QY, et al. Prognostic importance of the preoperative modified systemic inflammation score for patients with gastric cancer. Gastric Cancer. 2019;22:403–12.CrossRefPubMed
7.
go back to reference (2023) Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer 26:1–25 (2023) Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer 26:1–25
8.
go back to reference Sekiguchi M, Oda I, Matsuda T, Saito Y. Epidemiological trends and future perspectives of gastric cancer in Eastern Asia. Digestion. 2022;103:22–8.CrossRefPubMed Sekiguchi M, Oda I, Matsuda T, Saito Y. Epidemiological trends and future perspectives of gastric cancer in Eastern Asia. Digestion. 2022;103:22–8.CrossRefPubMed
9.
go back to reference Takeuchi D, Koide N, Suzuki A, Ishizone S, Shimizu F, Tsuchiya T, et al. Postoperative complications in elderly patients with gastric cancer. J Surg Res. 2015;198:317–26.CrossRefPubMed Takeuchi D, Koide N, Suzuki A, Ishizone S, Shimizu F, Tsuchiya T, et al. Postoperative complications in elderly patients with gastric cancer. J Surg Res. 2015;198:317–26.CrossRefPubMed
10.
go back to reference Yang JY, Lee HJ, Kim TH, Huh YJ, Son YG, Park JH, et al. Short- and long-term outcomes after gastrectomy in elderly gastric cancer patients. Ann Surg Oncol. 2017;24:469–77.CrossRefPubMed Yang JY, Lee HJ, Kim TH, Huh YJ, Son YG, Park JH, et al. Short- and long-term outcomes after gastrectomy in elderly gastric cancer patients. Ann Surg Oncol. 2017;24:469–77.CrossRefPubMed
11.
go back to reference Saito H, Kono Y, Murakami Y, Shishido Y, Kuroda H, Matsunaga T, et al. Prognostic significance of the preoperative ratio of C-reactive protein to albumin and neutrophil-lymphocyte ratio in gastric cancer patients. World J Surg. 2018;42:1819–25.CrossRefPubMed Saito H, Kono Y, Murakami Y, Shishido Y, Kuroda H, Matsunaga T, et al. Prognostic significance of the preoperative ratio of C-reactive protein to albumin and neutrophil-lymphocyte ratio in gastric cancer patients. World J Surg. 2018;42:1819–25.CrossRefPubMed
12.
go back to reference Murakami Y, Saito H, Kono Y, Shishido Y, Kuroda H, Matsunaga T, et al. Combined analysis of the preoperative and postoperative prognostic nutritional index offers a precise predictor of the prognosis of patients with gastric cancer. Surg Today. 2018;48:395–403.CrossRefPubMed Murakami Y, Saito H, Kono Y, Shishido Y, Kuroda H, Matsunaga T, et al. Combined analysis of the preoperative and postoperative prognostic nutritional index offers a precise predictor of the prognosis of patients with gastric cancer. Surg Today. 2018;48:395–403.CrossRefPubMed
13.
go back to reference Miyatani K, Sakano Y, Makinoya M, Miyauchi W, Shimizu S, Shishido Y, et al. A low cumulative perioperative prognostic nutritional index predicts poor long-term outcomes in patients with gastric cancer: a single-center retrospective study in Japan. Surg Today. 2023;53:1294–304.CrossRefPubMed Miyatani K, Sakano Y, Makinoya M, Miyauchi W, Shimizu S, Shishido Y, et al. A low cumulative perioperative prognostic nutritional index predicts poor long-term outcomes in patients with gastric cancer: a single-center retrospective study in Japan. Surg Today. 2023;53:1294–304.CrossRefPubMed
14.
go back to reference Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, et al. Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82:777–83.CrossRefPubMed Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, et al. Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82:777–83.CrossRefPubMed
15.
go back to reference Matsunaga T, Saito H, Osaki T, Takahashi S, Iwamoto A, Fukuda K, et al. Impact of geriatric nutritional risk index on outcomes after gastrectomy in elderly patients with gastric cancer: a retrospective multicenter study in Japan. BMC Cancer. 2022;22:540.CrossRefPubMedPubMedCentral Matsunaga T, Saito H, Osaki T, Takahashi S, Iwamoto A, Fukuda K, et al. Impact of geriatric nutritional risk index on outcomes after gastrectomy in elderly patients with gastric cancer: a retrospective multicenter study in Japan. BMC Cancer. 2022;22:540.CrossRefPubMedPubMedCentral
16.
go back to reference Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral
17.
go back to reference (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–23 (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–23
18.
go back to reference (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19 (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19
19.
go back to reference Lidoriki I, Schizas D, Frountzas M, Machairas N, Prodromidou A, Kapelouzou A, et al. GNRI as a prognostic factor for outcomes in cancer patients: a systematic review of the literature. Nutr Cancer. 2021;73:391–403.CrossRefPubMed Lidoriki I, Schizas D, Frountzas M, Machairas N, Prodromidou A, Kapelouzou A, et al. GNRI as a prognostic factor for outcomes in cancer patients: a systematic review of the literature. Nutr Cancer. 2021;73:391–403.CrossRefPubMed
20.
go back to reference Hayama T, Hashiguchi Y, Ozawa T, Watanabe M, Fukushima Y, Shimada R, et al. The preoperative geriatric nutritional risk index (GNRI) is an independent prognostic factor in elderly patients underwent curative resection for colorectal cancer. Sci Rep. 2022;12:3682.CrossRefPubMedPubMedCentral Hayama T, Hashiguchi Y, Ozawa T, Watanabe M, Fukushima Y, Shimada R, et al. The preoperative geriatric nutritional risk index (GNRI) is an independent prognostic factor in elderly patients underwent curative resection for colorectal cancer. Sci Rep. 2022;12:3682.CrossRefPubMedPubMedCentral
21.
go back to reference He L, Li Y, Qu L, Zhang F. Prognostic and clinicopathological value of the geriatric nutritional risk index in gastric cancer: a meta-analysis of 5,834 patients. Front Surg. 2022;9:1087298.CrossRefPubMed He L, Li Y, Qu L, Zhang F. Prognostic and clinicopathological value of the geriatric nutritional risk index in gastric cancer: a meta-analysis of 5,834 patients. Front Surg. 2022;9:1087298.CrossRefPubMed
22.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
23.
go back to reference Rodríguez SFMJ, Aguilar Martínez A, Manuel-y-Keenoy B. Influence of body weight on the prognosis of breast cancer survivors; nutritional approach after diagnosis. Nutr Hosp. 2013;28:1829–41. Rodríguez SFMJ, Aguilar Martínez A, Manuel-y-Keenoy B. Influence of body weight on the prognosis of breast cancer survivors; nutritional approach after diagnosis. Nutr Hosp. 2013;28:1829–41.
24.
go back to reference Lu L, Ji S, Jiang J, Yan Y. Body weight is a valid predictor of the long-term prognosis of cervical cancer. Comput Math Methods Med. 2022;2022:5613350.CrossRefPubMedPubMedCentral Lu L, Ji S, Jiang J, Yan Y. Body weight is a valid predictor of the long-term prognosis of cervical cancer. Comput Math Methods Med. 2022;2022:5613350.CrossRefPubMedPubMedCentral
25.
go back to reference Chai FY, Jiffre D. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery. Ann Surg. 2011;254:665.CrossRefPubMed Chai FY, Jiffre D. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery. Ann Surg. 2011;254:665.CrossRefPubMed
26.
go back to reference Oñate-Ocaña LF, Aiello-Crocifoglio V, Gallardo-Rincón D, Herrera-Goepfert R, Brom-Valladares R, Carrillo JF, et al. Serum albumin as a significant prognostic factor for patients with gastric carcinoma. Ann Surg Oncol. 2007;14:381–9.CrossRefPubMed Oñate-Ocaña LF, Aiello-Crocifoglio V, Gallardo-Rincón D, Herrera-Goepfert R, Brom-Valladares R, Carrillo JF, et al. Serum albumin as a significant prognostic factor for patients with gastric carcinoma. Ann Surg Oncol. 2007;14:381–9.CrossRefPubMed
27.
go back to reference Kuroda D, Sawayama H, Kurashige J, Iwatsuki M, Eto T, Tokunaga R, et al. Controlling Nutritional Status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection. Gastric Cancer. 2018;21:204–12.CrossRefPubMed Kuroda D, Sawayama H, Kurashige J, Iwatsuki M, Eto T, Tokunaga R, et al. Controlling Nutritional Status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection. Gastric Cancer. 2018;21:204–12.CrossRefPubMed
28.
go back to reference Matsui R, Inaki N, Tsuji T. Impact of malnutrition as defined by the global leadership initiative on malnutrition criteria on the long-term prognosis in older patients with gastric cancer after gastrectomy. Surg Today. 2023;53:578–87.CrossRefPubMed Matsui R, Inaki N, Tsuji T. Impact of malnutrition as defined by the global leadership initiative on malnutrition criteria on the long-term prognosis in older patients with gastric cancer after gastrectomy. Surg Today. 2023;53:578–87.CrossRefPubMed
29.
go back to reference Cai W, Yang H, Zheng J, Huang J, Ji W, Lu Y, et al. Global leaders malnutrition initiative-defined malnutrition affects long-term survival of different subgroups of patients with gastric cancer: a propensity score-matched analysis. Front Nutr. 2022;9:995295.CrossRefPubMedPubMedCentral Cai W, Yang H, Zheng J, Huang J, Ji W, Lu Y, et al. Global leaders malnutrition initiative-defined malnutrition affects long-term survival of different subgroups of patients with gastric cancer: a propensity score-matched analysis. Front Nutr. 2022;9:995295.CrossRefPubMedPubMedCentral
31.
go back to reference Li F, Zhang R, Liang H, Liu H, Quan J, Zhao J. The pattern of lymph node metastasis and the suitability of 7th UICC N stage in predicting prognosis of remnant gastric cancer. J Cancer Res Clin Oncol. 2012;138:111–7.CrossRefPubMed Li F, Zhang R, Liang H, Liu H, Quan J, Zhao J. The pattern of lymph node metastasis and the suitability of 7th UICC N stage in predicting prognosis of remnant gastric cancer. J Cancer Res Clin Oncol. 2012;138:111–7.CrossRefPubMed
32.
go back to reference Yang B, Liu T, Cui H, Lu Z, Fang G, Xue X, et al. The value of lymph nodes ratios in the prognosis of resectable remnant gastric cancer through the retrospective propensity score matching analysis. World J Surg Oncol. 2023;21:245.CrossRefPubMedPubMedCentral Yang B, Liu T, Cui H, Lu Z, Fang G, Xue X, et al. The value of lymph nodes ratios in the prognosis of resectable remnant gastric cancer through the retrospective propensity score matching analysis. World J Surg Oncol. 2023;21:245.CrossRefPubMedPubMedCentral
33.
go back to reference Iwasaki K, Barroga E, Shimoda Y, Enomoto M, Yamada E, Miyoshi K, et al. Clinicopathological features of remnant gastric cancer after gastrectomy. Am Surg. 2023;89:1381–6.CrossRefPubMed Iwasaki K, Barroga E, Shimoda Y, Enomoto M, Yamada E, Miyoshi K, et al. Clinicopathological features of remnant gastric cancer after gastrectomy. Am Surg. 2023;89:1381–6.CrossRefPubMed
34.
go back to reference Matsuo K, Lee SW, Tanaka R, Imai Y, Honda K, Taniguchi K, et al. T stage and venous invasion are crucial prognostic factors for long-term survival of patients with remnant gastric cancer: a cohort study. World J Surg Oncol. 2021;19:291.CrossRefPubMedPubMedCentral Matsuo K, Lee SW, Tanaka R, Imai Y, Honda K, Taniguchi K, et al. T stage and venous invasion are crucial prognostic factors for long-term survival of patients with remnant gastric cancer: a cohort study. World J Surg Oncol. 2021;19:291.CrossRefPubMedPubMedCentral
35.
go back to reference Hanada M, Yamauchi K, Miyazaki S, Hirasawa J, Oyama Y, Yanagita Y, et al. Geriatric Nutritional Risk Index, a predictive assessment tool, for postoperative complications after abdominal surgery: a prospective multicenter cohort study. Geriatr Gerontol Int. 2019;19:924–9.CrossRefPubMed Hanada M, Yamauchi K, Miyazaki S, Hirasawa J, Oyama Y, Yanagita Y, et al. Geriatric Nutritional Risk Index, a predictive assessment tool, for postoperative complications after abdominal surgery: a prospective multicenter cohort study. Geriatr Gerontol Int. 2019;19:924–9.CrossRefPubMed
36.
go back to reference Xie H, Tang S, Wei L, Gan J. Geriatric nutritional risk index as a predictor of complications and long-term outcomes in patients with gastrointestinal malignancy: a systematic review and meta-analysis. Cancer Cell Int. 2020;20:530.CrossRefPubMedPubMedCentral Xie H, Tang S, Wei L, Gan J. Geriatric nutritional risk index as a predictor of complications and long-term outcomes in patients with gastrointestinal malignancy: a systematic review and meta-analysis. Cancer Cell Int. 2020;20:530.CrossRefPubMedPubMedCentral
37.
go back to reference Schwegler I, von Holzen A, Gutzwiller JP, Schlumpf R, Mühlebach S, Stanga Z. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg. 2010;97:92–7.CrossRefPubMed Schwegler I, von Holzen A, Gutzwiller JP, Schlumpf R, Mühlebach S, Stanga Z. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg. 2010;97:92–7.CrossRefPubMed
38.
go back to reference Fukuda Y, Yamamoto K, Hirao M, Nishikawa K, Maeda S, Haraguchi N, et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol. 2015;22:S778–85.CrossRefPubMed Fukuda Y, Yamamoto K, Hirao M, Nishikawa K, Maeda S, Haraguchi N, et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol. 2015;22:S778–85.CrossRefPubMed
Metadata
Title
Using the geriatric nutritional risk index to predict outcomes in older patients with remnant gastric cancer after gastrectomy: a retrospective multicenter study in Japan
Authors
Tomoyuki Matsunaga
Hiroaki Saito
Tomohiro Osaki
Kenji Fukuda
Yoji Fukumoto
Sadamu Takahashi
Kenjiro Taniguchi
Akemi Iwamoto
Hirohiko Kuroda
Kuniyuki Katano
Shota Shimizu
Yuji Shishido
Kozo Miyatani
Teruhisa Sakamoto
Yoshiyuki Fujiwara
Publication date
23-04-2024
Publisher
Springer Nature Singapore
Published in
Surgery Today
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-024-02850-w