Nutritional status as a potential modulator of tumor morphology relative to disease-free survival: the role of Geriatric Nutritional Risk Index among patients with colorectal liver metastases

Background: Malnutrition is highly prevalent among oncologic patients and can affect both survival and therapeutic responses. The Geriatric Nutritional Risk Index (GNRI) is a validated nutritional score used in elderly populations to predict morbidity and mortality. However, the relationship between GNRI and tumor burden remains unknown. Methods: Patients aged >65 years who underwent curative-intent resection for colorectal liver metastasis (CRLM) were identified from an international, multi-institutional database. The association between clinicopathologic factors, tumor burden score (TBS), and GNRI was assessed. Results: A total of 230 patients aged >65 years who underwent curative resection for CRLM were included. The median GNRI was 104.5 (IQR, 111.5–129.8). TBS was categorized as low (n = 94 [45.2%]) or medium-high (n = 114 [54.8%]). A low GNRI defined as ≤92 was associated with worse median disease-free survival (DFS; 7.1 months [IQR 6.1–19.4] in the low GNRI group vs 19.6 months [IQR, 15.1–56.9] in the high GNRI group; P =.004). On multivariate Cox regression analysis, a low GNRI was associated with a higher risk of disease recurrence (hazard ratio, 1.91 [95% CI, 1.15–3.15]; P =.003). In contrast, an improved nutritional status (GNRI > 92) was associated with a longer median DFS among patients with both low TBS (56.87 months [IQR, 22.00-not available {NA}] vs 12.90 months [IQR, 4.60-NA]) and medium-high TBS (15.10 months [IQR, 11.60–21.75] vs 6.40 months [IQR, 4.20-NA]) (both P <.05). There was no difference in DFS among patients who had high TBS and a low-risk GNRI (>92) compared with individuals who had low TBS (P =.13). Conclusion: Improving the nutritional status of patients with resectable CRLM in the preoperative setting could mitigate the effect of a higher tumor burden on prognosis.