The prognostic significance of the geriatric nutritional risk index in metastatic gastric cancer patients aged 60 years and older: A retrospective study

Objectives: Malnutrition is commonly observed in gastric cancer, especially among older adults, and it negatively impacts disease prognosis. This study aims to investigate the relationship between the Geriatric Nutritional Risk Index (GNRI) and prognosis in metastatic gastric cancer patients aged 60 and older with metastastic gastric cancer. Materials and Methods:A total of 90 patients diagnosed with metastatic gastric cancer and followed at the Istanbul University Cerrahpaşa Cerrahpaşa Medical Faculty Oncology Outpatient Clinic between 2012 and 2024, who met the predefined inclusion criteria, were retrospectively included in this study. Demographic and laboratory data of these patients were reviewed retrospectively. The GNRI (Geriatric Nutritional Risk Index) was calculated using the serum albumin levels, height, and weight recorded at the time of metastasis. Based on the GNRI values, patients were categorized into high-risk and low-risk groups. Demographic characteristics, clinical features, and laboratory parameters were compared between these groups. Finally, COX regression analyses were performed to evaluate the prognostic factors factors associated in gastric cancer. Results: Of the 90 patients, 24 (27%) were female and 66 (73%) were male, with a median age of 68 years (range: 60–82). The median follow-up period was 18 months (range: 2–117). According to the GNRI, 36 patients (40%) were classified as high-risk and 54 patients (60%) as low-risk. The median follow-up duration was significantly longer in the low-risk group (20 months vs. 15 months, p < 0.007). During follow-up, disease progression occurred in 85 patients (95%), and 76 patients (85%) died. While no significant difference in progression-free survival was observed between the GNRI groups (p = 0.06), overall survival was significantly longer in the low-risk group (17.8 months vs. 14.03 months, p = 0.02).In univariate analysis, ECOG performance status (p = 0.022), disease status (p = 0.046), peritoneal metastasis (p = 0.04), and GNRI (p = 0.01) were identified as prognostic factors for overall survival. In multivariate analysis, an ECOG performance status ≥1, the presence of recurrent disease, and a high-risk GNRI (≤98) were found to be independent prognostic factors associated with worse overall survival. Conclusions: The GNRI was identified as an independent prognostic factor for overall survival in elderly patients with metastatic gastric cancer. As a simple, cost effective, and practical tool in clinical practice, the GNRI may serve as a useful predictor of overall survival in this patient population Keywords: Metastatic Gastric Cancer, Geriatric Nutritional Risk Index, Malnutrition