Geriatric Nutritional Risk Index and the Survival of Patients with Hepatocellular Carcinoma: A Meta-Analysis

Abstract

Malnutrition is a risk factor of adverse clinical outcome in patients with cancer. Recent studies suggest that geriatric nutritional risk index (GNRI) could reflect the nutritional status in patients with various clinical conditions. The aim of the systematic review and meta-analysis was to evaluate the association between GNRI and survival of patients with hepatocellular carcinoma (HCC). Observational studies evaluating the association between pretreatment GNRI and survival of patients with HCC were obtained by search of PubMed, Web of Science, Embase, Wanfang, and CNKI databases. A random-effects model was used to pool the results after incorporating the potential influence of heterogeneity. Seven cohort studies including 2636 patients with HCC contributed to the meta-analysis. Pooled results showed that HCC patients with low pretreatment GNRI were associated with poor overall survival [hazard ratio (HR): 1.77, 95% confidence interval (CI): 1.32 to 2.37, p<0.001; I2=66%) and progression-free survival (HR: 1.62, 95% CI: 1.39 to 1.89, p<0.001; I2=0%) as compared to those with normal GNRI. Sensitivity analyses by excluding one study at a time showed similar results (p all<0.05). Subgroup analyses showed that the association between low pretreatment GNRI and poor survival of patients with HCC was not significantly affected by age of the patients, main treatment, cutoff of GNRI, or the follow-up durations. In conclusion, malnutrition indicated by a low pretreatment GNRI may be a risk factor of poor survival of patients with HCC.

Key words

geriatric nutritional risk index - malnutrition - hepatocellular carcinoma - survival - meta-analysis

Publikationsverlauf

Eingereicht: 26. März 2023

Angenommen nach Revision: 02. Mai 2023

Artikel online veröffentlicht:
29. Juni 2023

• References

• 1 Chidambaranathan-Reghupaty S, Fisher PB, Sarkar D. Hepatocellular carcinoma (HCC): epidemiology, etiology and molecular classification. Adv Cancer Res 2021; 149: 1-61
• 2 Siegel RL, Miller KD, Wagle NS. et al. Cancer statistics, 2023. CA Cancer J Clin 2023; 73: 17-48
• 3 Kulik L, El-Serag HB. Epidemiology and management of hepatocellular carcinoma. Gastroenterology 2019; 156: 477-491 e471
• 4 Su GL, Altayar O, O'Shea R. et al. AGA clinical practice guideline on systemic therapy for hepatocellular carcinoma. Gastroenterology 2022; 162: 920-934
• 5 Gordan JD, Kennedy EB, Abou-Alfa GK. et al. Systemic therapy for advanced hepatocellular carcinoma: ASCO guideline. J Clin Oncol 2020; 38: 4317-4345
• 6 Natu A, Singh A, Gupta S. Hepatocellular carcinoma: understanding molecular mechanisms for defining potential clinical modalities. World J Hepatol 2021; 13: 1568-1583
• 7 Raoul JL, Frenel JS, Raimbourg J. et al. Current options and future possibilities for the systemic treatment of hepatocellular carcinoma. Hepat Oncol 2019; 6 HEP11
• 8 Jiri T, Igor K. , Mba Hepatocellular carcinoma future treatment options. Klin Onkol 2020; 33: 26-29
• 9 Rock CL, Thomson CA, Sullivan KR. et al. American cancer society nutrition and physical activity guideline for cancer survivors. CA Cancer J Clin 2022; 72: 230-262
• 10 Hamaker ME, Oosterlaan F, van Huis LH. et al. Nutritional status and interventions for patients with cancer – a systematic review. J Geriatr Oncol 2021; 12: 6-21
• 11 Aprile G, Basile D, Giaretta R. et al. The clinical value of nutritional care before and during active cancer treatment. Nutrients 2021; 13
• 12 Bozzetti F, Stanga Z. Does nutrition for cancer patients feed the tumour? A clinical perspective. Crit Rev Oncol Hematol 2020; 153: 103061
• 13 Bouillanne O, Morineau G, Dupont C. et al. Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 2005; 82: 777-783
• 14 Ruan GT, Zhang Q, Zhang X. et al. Geriatric nutrition risk index: prognostic factor related to inflammation in elderly patients with cancer cachexia. J Cachexia Sarcopenia Muscle 2021; 12: 1969-1982
• 15 Zhao H, Xu L, Tang P. et al. Geriatric nutritional risk index and survival of patients with colorectal cancer: a meta-analysis. Front Oncol 2022; 12: 906711
• 16 Yu J, Zhang W, Wang C. et al. The prognostic value of pretreatment geriatric nutritional risk index in esophageal cancer: a meta-analysis. Nutr Cancer 2022; 74: 3202-3210
• 17 Shen F, Ma Y, Guo W. et al. Prognostic value of geriatric nutritional risk index for patients with non-small cell lung cancer: a systematic review and meta-analysis. Lung 2022; 200: 661-669
• 18 He L, Li Y, Qu L. et al. Prognostic and clinicopathological value of the geriatric nutritional risk index in gastric cancer: a meta-analysis of 5,834 patients. Front Surg 2022; 9: 1087298
• 19 Page MJ, Moher D, Bossuyt PM. et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021; 372: n160
• 20 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
• 21 Higgins J, Thomas J, Chandler J. et al Cochrane handbook for systematic reviews of interventions version 6.2. The Cochrane Collaboration 2021; www.training.cochrane.org/handbook
• 22 Wells GA, Shea B, O'Connell D. et al The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2010; http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
• 23 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539-1558
• 24 Patsopoulos NA, Evangelou E, Ioannidis JP. Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol 2008; 37: 1148-1157
• 25 Egger M, Davey Smith G, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
• 26 Li L, Wang H, Yang J. et al. Geriatric nutritional risk index predicts prognosis after hepatectomy in elderly patients with hepatitis B virus-related hepatocellular carcinoma. Sci Rep 2018; 8: 12561
• 27 Zheng J, Pan S, Li Q. et al. Geriatric nutritional risk index predicts clinical outcomes in hepatocellular carcinoma after transarterial chemoembolization: A retrospective cohort study. Int J Clin Exp Med 2020; 13: 7566-7576
• 28 Kanno H, Goto Y, Sasaki S. et al. Geriatric nutritional risk index predicts prognosis in hepatocellular carcinoma after hepatectomy: a propensity score matching analysis. Sci Rep 2021; 11: 9038
• 29 Kinoshita A, Hagiwara N, Osawa A. et al. The geriatric nutritional risk index predicts tolerability of lenvatinib in patients with hepatocellular carcinoma. In Vivo 2022; 36: 865-873
• 30 Si Y, Xu P, Xu A. et al. Geriatric nutritional risk index as a prognostic factor in patients with hepatocellular carcinoma following transarterial chemoembolization: a retrospective study. Medicine (Baltimore) 2022; 101: e32322
• 31 Zhang D, Jing WJ, Zhang SL. et al. Predictive value of GNRI in postoperative complications and survival of elderly patients with digestive system tumor. J Hebei Med Univ 2022; 43: 1142-1152
• 32 Imaoka Y, Ohira M, Kobayashi T. et al. Impact of geriatric nutritional risk index after initial hepatectomy for hepatocellular carcinoma: a retrospective cohort study with the Hiroshima surgical study group of clinical oncology (HiSCO). J Gastrointest Surg 2023;
• 33 Umino R, Kobayashi Y, Akabane M. et al. Preoperative nutritional score predicts underlying liver status and surgical risk of hepatocellular carcinoma. Scand J Surg 2022; 111 14574969211061953
• 34 Castillo-Martinez L, Castro-Eguiluz D, Copca-Mendoza ET. et al. Nutritional assessment tools for the identification of malnutrition and nutritional risk associated with cancer treatment. Rev Invest Clin 2018; 70: 121-125
• 35 Bozzetti F, Mariani L, Lo Vullo S. et al. The nutritional risk in oncology: a study of 1,453 cancer outpatients. Support Care Cancer 2012; 20: 1919-1928
• 36 Isenring E, Cross G, Daniels L. et al. Validity of the malnutrition screening tool as an effective predictor of nutritional risk in oncology outpatients receiving chemotherapy. Support Care Cancer 2006; 14: 1152-1156
• 37 Reber E, Schonenberger KA, Vasiloglou MF. et al. Nutritional risk screening in cancer patients: the first step toward better clinical outcome. Front Nutr 2021; 8: 603936
• 38 Lee B, Cho JY, Han HS. et al. A scoring system to predict the risk of major complications after laparoscopic liver resection in elderly patients with hepatocellular carcinoma. Surg Endosc 2022; 36: 7756-7763
• 39 Akkiz H, Carr BI, Bag HG. et al. Serum levels of inflammatory markers CRP, ESR and albumin in relation to survival for patients with hepatocellular carcinoma. Int J Clin Pract 2021; 75: e13593
• 40 Zhao L, Wang J, Kong J. et al. The impact of body mass index on short-term and long-term surgical outcomes of laparoscopic hepatectomy in liver carcinoma patients: a retrospective study. World J Surg Oncol 2022; 20: 150
• 41 Hu B, Yang XB, Sang XT. Construction of a lipid metabolism-related and immune-associated prognostic signature for hepatocellular carcinoma. Cancer Med 2020; 9: 7646-7662
• 42 He TT, Xiao HW, Wusiman M. et al. Dietary intake of one-carbon metabolism-related nutrients and hepatocellular carcinoma survival in the Guangdong Liver Cancer Cohort. Food Funct 2022; 13: 8081-8090