Low Geriatric Nutritional Risk Index as a Poor Prognostic Marker for Second-Line Pembrolizumab Treatment in Patients with Metastatic Urothelial Carcinoma: A Retrospective Multicenter Analysis

Oncology ◽  
2020 ◽  
Vol 98 (12) ◽  
pp. 876-883
Author(s):  
Toshiki Etani ◽  
Taku Naiki ◽  
Yosuke Sugiyama ◽  
Takashi Nagai ◽  
Keitaro Iida ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Urothelial Carcinoma ◽  
Group Performance ◽  
Risk Index ◽  
Nutritional Risk ◽  
Second Line ◽  
Geriatric Nutritional Risk Index ◽  
Platinum Based Chemotherapy ◽  
Nutritional Risk Index ◽  
Metastatic Urothelial Carcinoma

<b><i>Background:</i></b> We evaluated the prognostic efficacy of the Geriatric Nutritional Risk Index (GNRI) in second-line pembrolizumab (PEM) therapy for patients with metastatic urothelial carcinoma (mUC). <b><i>Patients and Methods:</i></b> From January 2018 to October 2019, 52 mUC patients, treated previously with platinum-based chemotherapy, underwent second-line PEM therapy. Peripheral blood parameters were measured at the start of treatment: serum neutrophil-to-lymphocyte ratio (NLR), serum albumin, serum C-reactive protein (CRP), and body height and weight. PEM was intravenously administered (200 mg every 3 weeks). The patients were organized into two groups based on their GNRI (&#x3c;92 [low GNRI] and ≥92 [high GNRI]), and the data were retrospectively analyzed. Adverse events (AEs) were evaluated and imaging studies assessed for all patients. Analyses of survival and recurrence were performed using Kaplan-Meier curves. Potential prognostic factors affecting cancer-specific survival (CSS) were assessed by univariate and multivariate Cox regression analyses. <b><i>Results:</i></b> patients’ baseline characteristics, except for their BMI and objective response rate, did not significantly differ between the two groups. The median total number of cycles of PEM therapy was significantly higher for the high-GNRI group (<i>n</i> [range]: 6 [2–20] vs. 3 [1–6]). The median CSS with second-line PEM therapy was 3.6 months (95% confidence interval [CI]: 2.5–6.1) and 11.8 months (95% CI: 6.2–NA) in the low-GNRI and the high-GNRI group (<i>p</i> &#x3c; 0.01), respectively. Significant differences in CSS between the low- and high-CRP or -NRL groups were not found. Multivariate Cox proportional-hazards regression analysis revealed that a poor Eastern Cooperative Oncology Group performance status, visceral metastasis, and a low GNRI were significant prognostic factors for short CSS (95% CI: 1.62–6.10, HR: 3.14; 95% CI: 1.13–8.11, HR: 3.03; 95% CI: 1.32–8.02, HR: 3.25, respectively). Of the AEs, fatigue showed a significantly higher incidence in the low-GNRI group. <b><i>Conclusions:</i></b> For mUC patients receiving second-line PEM therapy, the GNRI is a useful predictive biomarker for survival outcome.

First Report of Oncological Outcome and Prognostic Analysis in a First-Line Setting of Short Hydration Gemcitabine and Cisplatin Chemotherapy for Patients with Metastatic Urothelial Carcinoma

Oncology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Taku Naiki ◽  
Takashi Nagai ◽  
Yosuke Sugiyama ◽  
Toshiki Etani ◽  
Satoshi Nozaki ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Risk Index ◽  
Objective Response ◽  
Oncological Outcome ◽  
Nutritional Risk ◽  
First Line ◽  
Prognostic Analysis ◽  
Nutritional Risk Index ◽  
Metastatic Urothelial Carcinoma ◽  
Gemcitabine And Cisplatin

<b><i>Objectives:</i></b> The aim of the study was to examine the effectiveness of a modified-short hydration gemcitabine and cisplatin (m-shGC) regimen for patients with metastatic urothelial carcinoma (mUC) and to assess the efficacy of a geriatric nutritional risk index (GNRI) with regard to prognosis. <b><i>Patients and Methods:</i></b> From January 2016 to July 2020, 68 patients with mUC underwent first-line m-shGC therapy with 70 mg/m<sup>2</sup> cisplatin and 1,000 mg/m<sup>2</sup> gemcitabine (days 1, 8, and 15), with 2,050 mL fluid replaced on the first day of each 28-day cycle. Prior to the start of treatment, the serum neutrophil-to-lymphocyte ratio (NLR), and levels of albumin and C-reactive protein (CRP) in serum, as well as body heights and weights were measured. Patients were grouped according to GNRI &#x3c;92 (low) or ≥92 (high). The analysis of data was done retrospectively. <b><i>Results:</i></b> Median follow-up was found to be 12.9 (range 1.7–50.2) months and the objective response rate (ORR) was 54.4% after m-shGC treatment. The ORR was significantly different when high and low-GNRI groups were compared (ORR: 28.0 vs. 69.8% in low- vs. high-GNRI groups). Median overall survival (OS) was calculated as 8.6 (95% confidence interval [CI]: 5.4–21.3) and 34.5 (95% CI: 20.5–NA) months for low- and high-GNRI groups, respectively (<i>p</i> &#x3c; 0.0001). Unlike for NLR and CRP, univariate and multivariate analyses revealed that low GNRI and visceral metastases were significant prognostic factors for short OS. <b><i>Conclusions:</i></b> First-line m-shGC showed a survival benefit for mUC, with GNRI a useful prognostic biomarker.

scholarly journals Association of the Geriatric Nutritional Risk Index with the survival of patients with non-small-cell lung cancer after platinum-based chemotherapy

2021 ◽  
Author(s):  
Masato Karayama ◽  
Yusuke Inoue ◽  
Hideki Yasui ◽  
Hironao Hozumi ◽  
Yuzo Suzuki ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Risk Index ◽  
Small Cell ◽  
Nutritional Risk ◽  
Small Cell Lung ◽  
Geriatric Nutritional Risk Index ◽  
First Line ◽  
Platinum Based Chemotherapy ◽  
Nutritional Risk Index ◽  
Platinum Chemotherapy

Abstract Background The nutritional status can potentially affect the efficacy of cancer therapy. We evaluated the relationships between the nutritional status and the efficacy of chemotherapy in patients with non-small-cell lung cancer (NSCLC). Methods The Geriatric Nutritional Risk Index (GNRI), calculated from body weight and serum albumin, was retrospectively evaluated in 148 patients with NSCLC who received first-line platinum-based chemotherapy and scored as low or high. Results Patients with a high GNRI had a significantly higher overall response rate (ORR; 61.8% [95% confidence interval {CI} = 52.5–70.3%] vs. 34.2% [95% CI = 21.2–50.1%, p < 0.004), longer median progression-free survival (PFS; 6.3 months [95% CI = 5.6–7.2 months] vs. 3.8 months [95% CI = 2.5–4.7 months], p < 0.001), and longer median overall survival (OS; 22.8 months [95% CI = 16.7–27.2 months] vs. 8.5 months [95% CI = 5.4–16.0 months], p < 0.001) than those with low GNRI. High GNRI was independently predictive of longer PFS and OS, but not ORR, in multivariate Cox proportional hazard analyses. In 71 patients who received second-line non-platinum chemotherapy, patients with high GNRI exhibited significantly longer PFS and OS than those with low GNRI (both p < 0.001). Conclusions GNRI was predictive of prolonged survival in patients with NSCLC who received first-line platinum-based chemotherapy and second-line non-platinum chemotherapy. Assessment of the nutritional status may be useful for predicting the efficacy of chemotherapy.

scholarly journals Utility of Geriatric Nutritional Risk Index in patients with lung cancer undergoing surgery

2020 ◽  
Vol 58 (4) ◽  
pp. 775-782 ◽  
Author(s):  
Haruaki Hino ◽  
Tomohito Saito ◽  
Hiroshi Matsui ◽  
Yohei Taniguchi ◽  
Tomohiro Murakawa
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Risk Index ◽  
Primary Lung Cancer ◽  
Lung Cancer Surgery ◽  
Nutritional Risk ◽  
Geriatric Nutritional Risk Index ◽  
Cancer Specific Survival ◽  
Nutritional Risk Index

Abstract OBJECTIVES The Geriatric Nutritional Risk Index (GNRI) based on serum albumin and body weight helps predict the risk of malnutrition and mortality in hospitalized elderly patients. However, its significance for patients with malignancy is unclear. We analysed the ability of GNRI to assess this risk in patients with lung cancer undergoing surgery. METHODS We retrospectively analysed the clinical characteristics and surgical outcomes of 739 patients with primary lung cancer who underwent surgery from 2006 to 2017 in a single institution. RESULTS GNRI values were ≤98 for 112 patients and &gt;98 for 627 patients; 532 patients had pathological stage I disease, 114 patients had stage II disease and 93 patients had stage III disease. Cox proportional hazards models revealed that age, GNRI value ≤98 and stages II and III diseases (all Ps &lt; 0.05) were significant negative prognostic factors for overall survival and that carcinoembryonic antigen level (P = 0.03), GNRI value ≤98 (P = 0.005) and stages II and III diseases (both Ps &lt; 0.001) were significant negative prognostic factors for cancer-specific survival. Rates of overall survival and cancer-specific survival stratified by lower and higher GNRI score were significantly different among patients aged 70 and older (P = 0.001 and P = 0.004, respectively) but not among patients aged 69 and younger (P = 0.09 and P = 0.12, respectively). CONCLUSIONS GNRI could help in predicting survival after lung cancer surgery, especially in older patients, and perioperative active nutritional support might improve the survival.

scholarly journals Association of the Geriatric Nutritional Risk Index with the survival of patients with non-small-cell lung cancer after platinum-based chemotherapy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masato Karayama ◽  
Yusuke Inoue ◽  
Hideki Yasui ◽  
Hironao Hozumi ◽  
Yuzo Suzuki ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Risk Index ◽  
Small Cell ◽  
Nutritional Risk ◽  
Small Cell Lung ◽  
Geriatric Nutritional Risk Index ◽  
First Line ◽  
Platinum Based Chemotherapy ◽  
Nutritional Risk Index ◽  
Platinum Chemotherapy

Abstract Background The nutritional status can potentially affect the efficacy of cancer therapy. The Geriatric Nutritional Risk Index (GNRI), a simple index for evaluating nutritional status calculated from body weight and serum albumin levels, has been reported to be associated with the prognosis of various diseases. However, the relationships between GNRI and the efficacy of platinum-based chemotherapy in patients with non-small-cell lung cancer (NSCLC) are unknown. Methods The pretreatment levels of GNRI were retrospectively evaluated in 148 chemo-naïve patients with advanced NSCLC who received first-line platinum-based chemotherapy and scored as low or high. Results Patients with a high GNRI had a significantly higher overall response rate (ORR; 44.5% [95% confidence interval {CI} = 35.6%–53.9%] vs. 15.8% [95% CI = 7.4%–30.4%, p = 0.002), longer median progression-free survival (PFS; 6.3 months [95% CI = 5.6–7.2 months] vs. 3.8 months [95% CI = 2.5–4.7 months], p < 0.001), and longer median overall survival (OS; 22.8 months [95% CI = 16.7–27.2 months] vs. 8.5 months [95% CI = 5.4–16.0 months], p < 0.001) than those with low GNRI. High GNRI was independently predictive of better ORR in multivariate logistic regression analysis and longer PFS and OS in multivariate Cox proportional hazard analyses. In 71 patients who received second-line non-platinum chemotherapy, patients with high GNRI exhibited significantly longer PFS and OS than those with low GNRI (both p < 0.001). Conclusions GNRI was predictive of prolonged survival in patients with NSCLC who received first-line platinum-based chemotherapy and second-line non-platinum chemotherapy. Assessment of the nutritional status may be useful for predicting the efficacy of chemotherapy.

scholarly journals Association of the Geriatric Nutritional Risk Index with the survival of patients with non-small-cell lung cancer after platinum-based chemotherapy

2021 ◽  
Author(s):  
Masato Karayama ◽  
Yusuke Inoue ◽  
Hideki Yasui ◽  
Hironao Hozumi ◽  
Yuzo Suzuki ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Risk Index ◽  
Small Cell ◽  
Nutritional Risk ◽  
Small Cell Lung ◽  
Geriatric Nutritional Risk Index ◽  
First Line ◽  
Platinum Based Chemotherapy ◽  
Nutritional Risk Index ◽  
Platinum Chemotherapy

Abstract Background The nutritional status can potentially affect the efficacy of cancer therapy. We evaluated the relationships between the nutritional status and the efficacy of chemotherapy in patients with non-small-cell lung cancer (NSCLC). Methods The Geriatric Nutritional Risk Index (GNRI), calculated from body weight and serum albumin, was retrospectively evaluated in 148 patients with NSCLC who received first-line platinum-based chemotherapy and scored as low or high. Results Patients with a high GNRI had a significantly higher overall response rate (ORR; 61.8% [95% confidence interval {CI} = 52.5–70.3%] vs. 34.2% [95% CI = 21.2–50.1%, p < 0.004), longer median progression-free survival (PFS; 6.3 months [95% CI = 5.6–7.2 months] vs. 3.8 months [95% CI = 2.5–4.7 months], p < 0.001), and longer median overall survival (OS; 22.8 months [95% CI = 16.7–27.2 months] vs. 8.5 months [95% CI = 5.4–16.0 months], p < 0.001) than those with low GNRI. High GNRI was independently predictive of longer PFS and OS, but not ORR, in multivariate Cox proportional hazard analyses. In 71 patients who received second-line non-platinum chemotherapy, patients with high GNRI exhibited significantly longer PFS and OS than those with low GNRI (both p < 0.001). Conclusions GNRI was predictive of prolonged survival in patients with NSCLC who received first-line platinum-based chemotherapy and second-line non-platinum chemotherapy. Assessment of the nutritional status may be useful for predicting the efficacy of chemotherapy.

scholarly journals Combined Predictive Value of Extracellular Fluid/Intracellular Fluid Ratio and the Geriatric Nutritional Risk Index for Mortality in Patients Undergoing Hemodialysis

Nutrients ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 2659 ◽  
Author(s):  
Takahiro Yajima ◽  
Kumiko Yajima ◽  
Hiroshi Takahashi ◽  
Keigo Yasuda
Keyword(s):  
Risk Model ◽  
Risk Index ◽  
Survival Rates ◽  
Extracellular Fluid ◽  
Nutritional Risk ◽  
Geriatric Nutritional Risk Index ◽  
Protein Energy Wasting ◽  
Intracellular Fluid ◽  
Net Reclassification Improvement ◽  
Nutritional Risk Index

The ratio of extracellular fluid (ECF) to intracellular fluid (ICF) may be associated with mortality in patients undergoing hemodialysis, possibly associated with protein-energy wasting. We therefore investigated the relationship of the ECF/ICF ratio and the geriatric nutritional risk index (GNRI) with the all-cause and cardiovascular-specific mortality in 234 patients undergoing hemodialysis. Bioimpedance analysis of the ECF and ICF was performed and the ECF/ICF ratio was independently associated with GNRI (β = −0.247, p < 0.0001). During a median follow-up of 2.8 years, 72 patients died, of which 29 were cardiovascular. All-cause mortality was independently associated with a lower GNRI (adjusted hazard ratio [aHR] 3.48, 95% confidence interval [CI] 2.01–6.25) and a higher ECF/ICF ratio (aHR 11.38, 95%CI 5.29–27.89). Next, we divided patients into four groups: group 1 (G1), higher GNRI and lower ECF/ICF ratio; G2, lower GNRI and lower ECF/ICF ratio; G3, higher GNRI and higher ECF/ICF ratio; and G4, lower GNRI and higher ECF/ICF ratio. Analysis of these groups revealed 10-year survival rates of 91.2%, 67.2%, 0%, and 0% in G1, G2, G3, and G4, respectively. The aHR for G4 versus G1 was 43.4 (95%CI 12.2–279.8). Adding the GNRI alone, the ECF/ICF ratio alone, or both to the established risk model improved the net reclassification improvement by 0.444, 0.793 and 0.920, respectively. Similar results were obtained for cardiovascular mortality. In conclusion, the ECF/ICF ratio was independently associated with GNRI and could predict mortality in patients undergoing hemodialysis. Combining the GNRI and ECF/ICF ratio could improve mortality predictions.

Prognosis in Head and Neck Cancer: Importance of Nutritional and Biological Inflammatory Status

2021 ◽  
pp. 019459982110045
Author(s):  
Nicolas Saroul ◽  
Mathilde Puechmaille ◽  
Céline Lambert ◽  
Achraf Sayed Hassan ◽  
Julian Biau ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Prognostic Factors ◽  
Inflammatory Response ◽  
Nutritional Status ◽  
Head And Neck ◽  
Neck Cancer ◽  
Risk Index ◽  
Nutritional Risk ◽  
Inflammatory Status ◽  
Nutritional Risk Index

Objectives To determine the importance of nutritional status, social status, and inflammatory status in the prognosis of head and neck cancer. Study Design Single-center retrospective study of prospectively collected data. Setting Tertiary referral center. Methods Ninety-two consecutive patients newly diagnosed for cancer of the upper aerodigestive tract without metastases were assessed at time of diagnosis for several prognostic factors. Nutritional status was assessed by the nutritional risk index, social status by the EPICES score, and inflammatory status by the systemic inflammatory response index. The primary endpoint was overall survival. Results In multivariable analysis, the main prognostic factors were the TNM classification (hazard ratio [HR] = 3.34, P = .002, for stage T3-4), malnutrition as assessed by the nutritional risk index (HR = 3.64, P = .008, for severe malnutrition), and a systemic inflammatory response index score ≥1.6 (HR = 3.32, P = .02). Social deprivation was not a prognostic factor. Conclusion Prognosis in head and neck cancer is multifactorial; however, malnutrition and inflammation are important factors that are potentially reversible by early intervention.

scholarly journals Association between geriatric nutritional risk index and stroke risk in hemodialysis patients: 10-Years outcome of the Q-Cohort study

2021 ◽  
Vol 323 ◽  
pp. 30-36
Author(s):  
Shoji Tsuneyoshi ◽  
Yuta Matsukuma ◽  
Yasuhiro Kawai ◽  
Hiroto Hiyamuta ◽  
Shunsuke Yamada ◽  
...  
Keyword(s):  
Cohort Study ◽  
Stroke Risk ◽  
Risk Index ◽  
Hemodialysis Patients ◽  
Nutritional Risk ◽  
Geriatric Nutritional Risk Index ◽  
Nutritional Risk Index
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