The Nutritional Status as a potential modulator of tumor morphology impact on disease free survival: the role of Geriatric Nutritional Risk Index among patients with Colorectal Liver Metastases.

Abstract

Malnutrition is highly prevalent among oncologic patients and can impact both survival and therapeutic response. The Geriatric Nutritional Risk Index (GNRI) is a validated nutritional score used in elderly populations to predict morbidity and mortality, however the relation of GNRI with tumor burden remains unknown.Patients over 65 years old who underwent curative-intent resection for colorectal liver metastases (CRLM) were identified from an international, multi-institutional database. The association between clinicopathologic factors, Tumor Burden Score (TBS) and GNRI was assessed.A total of 230 patients older than 65 years who underwent curative resection for CRLM were included. 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 = 92 was associated with worse median DFS (7.1 months [IQR 6.1-19.4] vs. 19.6 months [IQR 15.1-56.9]) (p=0.004). On multivariable Cox regression analysis, a low GNRI was associated with higher risk of disease recurrence (HR 1.91, 95% CI 1.15-3.15; p=0.003). 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 22.0 - NA] vs. 12.9 months [4.6 - NA]) and medium-high TBS (15.1 months [IQR 11.6 - 21.75] vs. 6.4 months [IQR 4.2 - NA])(both p<0.05). Among individuals with high TBS and a no-low risk GNRI (>92), there was no difference in DFS compared with patients who had low TBS (p= 0.13).Improving the nutritional status in the preoperative setting of patients with resectable CRLM could mitigate the impact of a higher tumor burden on prognosis.Malnutrition represents a common condition among oncologic patients and can have a strong impact on response to therapy, short term postoperative outcomes and long-term prognosis. The Geriatric Nutritional Risk Index was utilized as an indicator of nutritional status among over 65 years old patients with colorectal liver metastases. Nutritional status was associated with disease-free survival (DFS) with patients having a higher tumor burden score and a better nutritional status had no statistically significant difference in DFS when compared with patients with low TBS.

View details for DOI 10.1016/j.gassur.2025.102137

View details for PubMedID 40609627