The Prognostic Role of Geriatric Nutritional Risk Index in Periampullary Cancer Patients Undergoing Pancreaticoduodenectomy: A Propensity Score-Matched Survival Study

TL;DR

This study shows that a simple nutritional score called GNRI can predict survival and complications in patients undergoing a major cancer surgery.

Contribution

The study demonstrates GNRI's prognostic value in periampullary cancer patients undergoing pancreaticoduodenectomy using a large database and propensity score matching.

Findings

Poor GNRI scores correlate with shorter survival and higher post-operative complications in periampullary cancer patients.

The association between GNRI and outcomes is consistent across pancreatic and other nearby cancers.

Low GNRI scores are linked to increased short-term mortality and adverse perioperative outcomes.

Abstract

Malnutrition is common in patients with periampullary cancers and can negatively affect recovery and survival after major surgery. This study focused on the Geriatric Nutritional Risk Index (GNRI), a simple tool that uses basic health data to assess a patient’s nutrition status before surgery. This study reviewed medical records of patients who underwent pancreaticoduodenectomy using the largest private healthcare database in Taiwan, which found that patients with poor GNRI scores had shorter survival, more post-operative complications, and higher short-term death rates. These results were consistent in both pancreatic and other nearby cancers. Our findings suggest that GNRI may be a practical and cost-effective way to identify high-risk patients before surgery.

Background: The Geriatric Nutritional Risk Index (GNRI) is a simple tool for nutritional assessment, but its long-term prognostic value in patients undergoing pancreaticoduodenectomy (PD) remains unclear. Methods: This retrospective study included adult patients who underwent PD between January 2014 and December 2023 at Chang Gung Memorial Hospital. Patients were grouped by GNRI: inferior (<82), moderate (82–98), and superior (≥98). Propensity score matching was performed based on age, sex, cancer type, surgical approach, and ASA status. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Results: Among 371 patients, inferior GNRI was associated with worse median survival time (18.64 vs. 34.62 months, HR = 2.953, p < 0.001). This association was observed in both pancreatic cancer and other periampullary malignancies. Inferior GNRI also correlated with higher short-term mortality and adverse perioperative outcomes, including longer ICU stay, and greater need for ventilator support, reintubation, reoperation and total parenteral nutrition (TPN). Conclusions: Preoperative GNRI is a strong predictor of survival and short-term outcomes in PD patients. Early nutritional assessment may aid risk stratification and intervention.

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