Nutritional status as a potential modulator of tumor morphology relative to disease-free survival: the role of Geriatric Nutritional Risk Index among patients with colorectal liver metastases

Background: Malnutrition is highly prevalent among oncologic patients and can affect both survival and therapeutic responses. The Geriatric Nutritional Risk Index (GNRI) is a validated nutritional score used in elderly populations to predict morbidity and mortality. However, the relationship between GNRI and tumor burden remains unknown. Methods: Patients aged > 65 years who underwent curative-intent resection for colorectal liver metastasis (CRLM) were identified from an international, multi-institutional database. The association between clinicopathologic factors, tumor burden score (TBS), and GNRI was assessed. Results: A total of 230 patients aged > 65 years who underwent curative resection for CRLM were included. The 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 defined as <= 92 was associated with worse median disease-free survival (DFS; 7.1 months [IQR 6.1-19.4] in the low GNRI group vs 19.6 months [IQR, 15.1-56.9] in the high GNRI group; P =.004). On multivariate Cox regression analysis, a low GNRI was associated with a higher risk of disease recurrence (hazard ratio, 1.91 [95% CI, 1.15-3.15]; P =.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, 22.00-not available {NA}] vs 12.90 months [IQR, 4.60-NA]) and medium-high TBS (15.10 months [IQR, 11.60-21.75] vs 6.40 months [IQR, 4.20-NA]) (both P <.05). There was no difference in DFS among patients who had high TBS and a low-risk GNRI (> 92) compared with individuals who had low TBS (P =.13). Conclusion: Improving the nutritional status of patients with resectable CRLM in the preoperative setting could mitigate the effect of a higher tumor burden on prognosis. (c) 2025 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.