Purpose

The Geriatric Nutrition Risk Index (GNRI) is a simple and validated tool used to assess the nutritional status of elderly patients and predict the risk of short-term postoperative complications, as well as the long-term prognosis, after cancer surgery. In this study, we aimed to evaluate the predictive value of GNRI for the long-term postoperative prognosis in elderly patients with primary non-muscle-invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumor (TURBT).

Methods

We retrospectively analyzed data from 292 elderly patients with primary NMIBC. Using X-tile software, we divided the cohort into two groups based on GNRI and determined the cut-off value for postoperative recurrence-free survival (RFS). Propensity score matching (PSM) with a ratio of 1:3, Kaplan–Meier analysis, log-rank test, and COX proportional hazards regression were used to assess the correlation between GNRI and prognosis and identify factors predicting recurrence and progression.

Results

In the entire cohort, the 3 year recurrence group had significantly lower GNRI compared to the 3 year non-recurrence group (P = 0.0109). The determined GNRI cut-off value was 93.82. After PSM, the low GNRI group had significantly lower RFS (P < 0.0001) and progression-free survival (PFS) (P = 0.0040) than the high GNRI group. Multivariate COX regression showed that GNRI independently predicted RFS (HR 2.108; 95% CI 1.266–3.512; P = 0.004) and PFS (HR 2.155; 95% CI 1.135–4.091; P = 0.019) in elderly patients with primary NMIBC.

Conclusion

Preoperative GNRI is a prognostic marker for disease recurrence and progression in elderly patients with primary NMIBC undergoing TURBT.

中文翻译：

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老年营养风险指数作为老年非肌层浸润性膀胱癌患者的预后因素：一项倾向评分匹配研究

目的

老年营养风险指数 (GNRI) 是一种简单且经过验证的工具，用于评估老年患者的营养状况并预测癌症手术后短期术后并发症的风险以及长期预后。在本研究中，我们旨在评估 GNRI 对接受经尿道膀胱肿瘤切除术 (TURBT) 的原发性非肌层浸润性膀胱癌 (NMIBC) 老年患者术后长期预后的预测价值。

方法

我们回顾性分析了 292 名原发性 NMIBC 老年患者的数据。使用 X-tile 软件，我们根据 GNRI 将队列分为两组，并确定术后无复发生存期 (RFS) 的截止值。采用1:3比例的倾向评分匹配（PSM）、Kaplan-Meier分析、对数秩检验和COX比例风险回归来评估GNRI与预后之间的相关性，并确定预测复发和进展的因素。

结果

在整个队列中，3 年复发组的 GNRI 显着低于 3 年未复发组 (P = 0.0109)。确定的 GNRI 截止值为 93.82。PSM 后，低 GNRI 组的 RFS（P < 0.0001）和无进展生存期（PFS）（P = 0.0040）显着低于高 GNRI 组。多变量 COX 回归显示，GNRI 独立预测原发性 NMIBC 老年患者的 RFS（HR 2.108；95% CI 1.266–3.512；P = 0.004）和 PFS（HR 2.155；95% CI 1.135–4.091；P = 0.019）。

结论

术前 GNRI 是接受 TURBT 的原发性 NMIBC 老年患者疾病复发和进展的预后标志物。