The prognostic value of geriatric nutritional risk index and prognostic nutritional index in patients with metastatic gastric cancer and its effect on overall survival

Objective: Malnutrition, which we frequently encounter in patients with gastrointestinal system cancer; affects prognosis, quality of life, and survival. In our study, it was aimed to examine the prognostic value and effects of the Prognostic Nutritional Index (PNI) and Geriatric Nutritional Risk Index (GNRI) on survival in patients with metastatic gastric cancer and to determine which index is more predictive. Method: The data of patients with metastatic gastric cancer who applied to Akdeniz University Hospital Medical Oncology outpatient clinic between 2009 and 2020 were retrospectively scanned and 124 patients were included in the study. The indices were calculated as follows; PNI=[10 x serum albumin (g/dl)]+ [0.005 x total lymphocyte count (per mm3)], GNRI=[1.489 x albumin (g/l)] + [ 41.7 x (bodyweight / ideal body weight) ]. Statistical analysis was done with SPSS (version 23.0) program. Kaplan-Meier analysis and Log-Rank test were used for survival analysis. Factors affecting overall survival were analyzed by univariate and multivariate Cox regression analysis. The values of the indices in predicting cutoff point and overall survival were recorded by calculating AUC by ROC analysis and compared with each other. Results: The median overall survival of the patients was 10 (8,983-11,017) months. During follow-up, 110 patients died. 66.9% (83) of the 124 patients included were male and the mean age at diagnosis was 58. Primary tumor located at the cardio esophageal junction increased CRP value, decreased lymphocyte count, and low PNI (≤44.05) significantly decreased overall survival (p<0.05). The primary tumor location at the cardio esophageal junction was an independent prognostic factor for mortality (HR: 2.717; 95% CI: 1.292-5.711; p=0.008). Conclusion: Although PNI is not an independent risk factor for overall survival in patients with metastatic gastric cancer, it is an indicator of survival. PNI has also been identified as a better predictor of overall survival compared to GNRI in all patients and patients over 65 years of age. Keywords: Gastric Cancer, Prognostic Nutritional Index, Geriatric Nutritional Risk Index, Prognostic Factors