Geriatric nutritional risk index is not an independent predictor in patients with diffuse large B-cell lymphoma

Prognostic value of geriatric nutritional risk index in patients with diffuse large B-cell lymphoma: a meta-analysis

BACKGROUND

Geriatric nutritional risk index (GNRI) on the prognosis of patients with diffuse large B-cell lymphoma (DLBCL) remains unclear. The purpose of this meta-analysis was to discuss the value of the GNRI in evaluating long-term outcomes in DLBCL.

METHODS

We systematically and roundly retrieved PubMed, Cochrane Library, Embase, Scopus and Web of Science electronic databases from inception of the databases to March 20, 2023. At the same time, we calculated the pool hazard ratios (HRs) with their 95% confidence interval (CI) for overall survival and progression-free survival to assess the effect of GNRI on the prognosis of DLBCL patients.

RESULTS

In our primary meta-analysis, 7 trials with a total of 2448 patients were enrolled. Results showed that lower level of GNRI was related to poorer overall survival (HR = 1.78, 95% CI 1.27, 2.50, p < 0.01) and worse progression-free survival (HR = 2.31, 95% CI 1.71, 3.13, p < 0.01) in DLBCL patients.

CONCLUSION

The results of our meta-analysis indicate that a lower GNRI significantly associated with poorer prognosis for DLBCL. It is believed that GNRI was a promisingly predictive indicator of survival outcomes in DLBCL patients. However, large multicenter prospective studies are necessary to verify the results.

The impact of malnutrition on mortality and complications of hematopoietic stem cell transplantation in patients with acute leukemia

BACKGROUND & AIMS

Malnutrition is common in hematopoietic stem cell transplantation (HSCT) patients. However, there are few studies on the association between malnutrition and post-transplant outcomes, with inconsistent results. No standard screening tool has been established for malnutrition in these patients. Previous research suggests the Global Leadership Initiative on Malnutrition (GLIM) criteria is effective in predicting outcomes in other cancers. This study investigates the link between malnutrition based on the GLIM criteria with mortality and complications following allogeneic HSCT.

METHODS

This single-center, observational, longitudinal, and prospective study of 98 adult leukemia patients at the Hematology Center of Shariati Hospital in Tehran, Iran, monitored patients before transplantation until 100 days after the procedure, focusing on overall survival and mortality as a primary outcome, and secondary endpoints including oral mucositis, acute GVHD, infection during hospitalization, and readmission rates.

RESULTS

This study involved 98 allogeneic HSCT patients with a median age of 38 years old, 64.3 % with acute myeloid leukemia (AML), and 35.7 % with acute lymphoblastic leukemia (ALL). Among them, 26.5 % were categorized as malnourished based on GLIM criteria. During 100 days of follow-up, 13 patients died, but there was no significant difference in overall survival and mortality between malnourished and well-nourished patients. Malnourished patients demonstrated a noticeable upward trend in the incidence of oral mucositis, hospital readmission, and infection during their hospitalization. It is important to highlight that although this observed trend is discernible, it did not attain statistical significance in statistical analyses (P > 0.05).

CONCLUSION

The current study determined that, when assessed using the GLIM criteria, malnutrition did not exert a statistically significant influence on survival, mortality, or complications within the specified age range of 18-55 years, underscoring its limited impact on this cohort of younger patients.

Geriatric nutritional risk index as a predictor of prognosis in hematologic malignancies: a systematic review and meta-analysis

Objective

Recent studies have reported inconsistent results regarding the association between geriatric nutritional risk index (GNRI) and clinical outcomes in patients with hematologic malignancies (HMs). We performed a meta-analysis to evaluate the effect of low GNRI on the overall survival (OS) and progression-free survival (PFS) in patients with HMs.

Research Methods and Procedures

We conducted the research via PubMed, Embase, and Cochrane Library databases to identify trials. Exploring the association between GNRI and prognosis in patients with HMs. A meta-analysis of OS and PFS was performed. Quality In Prognostic Studies instrument and Newcastle-Ottawa quality assessment Scale were used to assess the quality of included trials.

Results

Fourteen studies enrolling 3,524 patients with HMs were included. Low GNRI was associated with shorter OS (Hazard ratio (HR) = 1.77; 95% CI = 1.44-2.18, p < 0.01) and PFS (HR = 1.63; 95% CI = 1.17-2.27, p < 0.01) in patients with HMs. In the subgroup analysis, GNRI was not significantly associated with prognosis in Chinese patients with HMs (OS, HR =1.33; 95% CI = 0.89-1.98, p = 0.16; PFS, HR = 1.70; 95% CI = 0.72-4.01, p = 0.23). For the subgroup with a GNRI cutoff value less than 98, there was no significant difference in PFS (HR = 1.34; 95% CI = 0.98-1.83, p = 0.06).

Conclusion

Low GNRI negatively impacted on the prognosis in patients with HMs. Prospective studies to identify the best cut-off value for GNRI are required.

Comparison of three malnutrition screening tools prior to allogeneic hematopoietic stem-cell transplantation

Background

Previous studies have shown that malnutrition before hematopoietic stem cell transplantation (HSCT) is associated with poor patient prognoses. There is inconsistency among studies on which nutritional status screening tool is appropriate for malnutrition diagnosis before allo-HSCT. The present study aimed to compare nutritional screening tools in patients with leukemia before allo-HSCT.

Methods

An observational, cross-sectional, and single-center study was conducted in Tehran, Iran. One hundred four adults allo-HSCT candidates aged 18-55 years with leukemia were selected sequentially. Malnutrition assessment was done using three tools, the Global Leadership Initiative on Malnutrition (GLIM), nutritional risk screening 2002 (NRS-2002) and European Society for Clinical Nutrition and Metabolism (ESPEN) criteria. The agreement between malnutrition assessment tools was evaluated with Cohen's kappa.

Results

The agreement between GLIM and NRS-2002 was perfect (κ = 0.817, p < 0.001), while the agreement between GLIM and ESPEN was fair (κ = 0.362, p < 0.001). The agreement between NRS-2002 and ESPEN was fair (κ = 0.262, p < 0.001). We also found a moderate agreement for all tools (κ = 0.489, p < 0.001).

Conclusion

NRS-2002 is an accepted tool for screening malnutrition in hospitalized patients. In the current study, the GLIM criterion perfectly agreed with the NRS-2002. Further studies in the HSCT setting are needed to introduce a valid tool.

The prognostic impact of comorbidity, nutritional and performance status on patients with diffuse large B cell lymphoma

Background

The aim of the study was to investigate the impact of nutritional status, comorbidity, and performance status on patients with diffuse large B-cell lymphoma (DLBCL).

Methods

A retrospective study was conducted on 112 DLBCL patients who were diagnosed at our center between 2009 and 2018. Demographic and disease characteristics and laboratory test results were recorded. Assessments were made using the age-adjusted Charlson comorbidity index (CCI-A) for comorbidity, albumin level for nutritional status, and Eastern Cooperative Oncology Group (ECOG) score for performance status.

Results

The mean age of the patients was found to be 62.63 ± 15.16 years. The ECOG score of 65 patients (69.1%) was in the range of 0-1. The mean follow-up time of the patients was determined to be 25.24 ± 25.11 months, and at the end of the follow-up period, 64 patients (57.1%) were survivors. The progression-free survival (PFS), overall survival (OS), and 5-year OS rates of those with CCI-A > 4 were found to be significantly lower than those with CCI-A score ≤4 (P < 0.05). As a result of the Cox-Regression (Backward: LR method) analysis, ECOG and albumin levels were found to be independent risk factors for both OS and PFS (P < 0.05).

Conclusion

This study demonstrated that CCI-A, ECOG, and nutritional status are independent prognostic markers for DLBCL patients. Initial evaluation of these patients should include all these parameters, which are easily available at the time of diagnosis.

Cytokine profiles in patients with newly diagnosed diffuse large B-cell lymphoma: IL-6 and IL-10 levels are associated with adverse clinical features and poor outcomes

BACKGROUND

The development of diffuse large B-cell lymphoma (DLBCL), a prevalent subgroup of non-Hodgkin lymphoma (NHL), potentially involves various cytokines. We aimed to determine the correlation between deregulated serum levels of cytokines and clinical features and investigate their impact on the prognosis of patients with DLBCL.

METHODS

We conducted a retrospective study of 77 patients with newly diagnosed DLBCL to explore the relationships between different cytokines, adverse clinical features, and poor outcomes. The Mann-Whitney U test was used to compare the cytokine profiles between patients with DLBCL and healthy controls. The Kaplan-Meier method was used to analyze the probability of survival, and the log-rank tests were used to evaluate the differences between survival curves. The Cox proportional hazards regression model was used to performed univariate and multivariate analyses to evaluate prognostic variables for survival analyze.

RESULTS

Serum levels of interleukin-2 (IL-2), tumor necrosis factor (TNF)-α, IL-6, IL-10, and IFN-γ were significantly elevated in patients with untreated DLBCL. Serum levels of IL-6 and IL-10 were significantly higher in patients with an International Prognostic Index (IPI) of 3-5, bone marrow involvement, serum levels of LDH ≥ 250 U/L, and β2-microglobulin (β2-MG) levels ≥ 2.3 mg/L. Patients with B symptoms only had higher serum IL-10 levels, whereas patients with a partial response or no response to treatment had significantly elevated serum levels of IL-6 as well as IL-10. Significant positive correlations were observed between the levels of IL-6 and IL-10 with those of β2-MG and LDH. Patients with levels of IL-6 ≥ 4.5 or IL-10 ≥ 5.0 pg/mL, as well as combined elevated IL-6 and IL-10 levels, exhibited shorter progression-free survival and overall survival. Additionally, univariate and multivariate analyses revealed that serum levels of IL-6 ≥ 4.5 pg/mL and IL-10 ≥ 5.0 pg/mL and IPI 3-5 were independent prognostic factors for relapse and survival in patients with DLBCL.

CONCLUSIONS

Pre-treatment serum IL-6 and IL-10 levels in patients with newly diagnosed DLBCL might be powerful markers for determining treatment response and predicting the prognosis of DLBCL.

The Prognostic Impact of Pretreatment Geriatric Nutritional Risk Index in Patients with Diffuse Large B-Cell Lymphoma

The prognostic value of the geriatric nutritional risk index (GNRI) is not clear in patients with diffuse large B-cell lymphoma (DLBCL). This study was designed to analyze the GNRI in DLBCL patients and to investigate its prognostic value in DLBCL. The archive records of DLBCL patients between 2008 and 2020 at the Akdeniz University Hospital were retrospectively analyzed. A total of 206 patients with DLBCL were recruited and classified into two GNRI-based groups based on nutrition status. The GNRI cut off value was determined by ROC analysis. In the univariate Cox regression analysis for overall survival (OS), age, lactate dehydrogenase, B symptoms, infiltration of bone marrow, and the GNRI were determined as prognostic factors for mortality. The OS of patients with a GNRI ≤104.238 was significantly lower than that of patients with a GNRI >104.238 (p = 0.001). The progression-free survival (PFS) of patients with GNRI ≤104.238 was significantly lower compared to the patients with GNRI >104.238 (p = 0.010). Based on the results of the present study with a relatively large hospital-based cohort, the GNRI can be recommended for use as an independent prognostic marker for OS and PFS in patients with DLBCL.

Prognostic and clinicopathological role of geriatric nutritional risk index in patients with diffuse large B-cell lymphoma: A meta-analysis

Background

Previous studies have explored the relationship between the geriatric nutritional risk index (GNRI) and survival outcomes of diffuse large B-cell lymphoma (DLBCL) cases, but the results were inconsistent. Consequently, the present meta-analysis was conducted to investigate how GNRI affects DLBCL and its function in terms of prognosis.

Methods

The Web of Science, PubMed, Embase, and Cochrane Library databases were thoroughly searched until January 18, 2023. We calculated combined hazard ratios (HRs) and 95% confidence intervals (CIs) to estimate the relationship between the GNRI and survival outcomes of patients with DLBCL.

Results

This meta-analysis included seven articles involving 2,353 cases. A lower level of GNRI predicted dismal overall survival (HR=1.40, 95% CI=1.25-1.56, p<0.001) and inferior progression-free survival (HR=1.46, 95% CI=1.19-1.80, p<0.001) of DLBCL patients. Moreover, a low GNRI was significantly related to Eastern Cooperative Oncology Group Performance Status ≥2 (odds ratio [OR]=4.55, 95% CI=2.75-7.54, p<0.001), Ann Arbor stage III-IV (OR=2.91, 95% CI=2.38-3.57, p<0.001), B symptoms (OR=3.51, 95% CI=2.34-5.29, p<0.001), and extranodal disease (OR=2.90, 95% CI=2.32-3.63, p<0.001).

Conclusion

A lower GNRI level predicted poorer short- and long-term prognosis in patients with DLBCL. A low GNRI was correlated with clinical factors of disease progression in DLBCL patients.

The preoperative geriatric nutritional risk index (GNRI) is an independent prognostic factor in elderly patients underwent curative resection for colorectal cancer

The world is becoming longer-lived, and the number of elderly colorectal cancer patients is increasing. It is very important to identify simple and inexpensive postoperative predictors in elderly colorectal cancer patients. The geriatric nutritional risk index (GNRI) is a marker of systemic nutrition and is associated with poor survival in various kinds of cancers. A few reports have investigated recurrence factors using preoperative GNRI with CRC (colorectal cancer) patients. This study aimed to investigate whether preoperative GNRI is associated with recurrence-free survival (RFS) and overall survival (OS) in elderly patients with CRC. This study retrospectively enrolled 259 patients with Stage I–III CRC who were more than 65 years old and underwent curative surgery at a single institution in 2012–2017. We classified them into low GNRI (RFS: ≤ 90.5, OS ≤ 101.1) group and high GNRI (RFS: > 90.5, OS > 101.1) group. Multivariable analyses showed low GNRI group was an independent risk factor for 3-year RFS (P = 0.006) and OS (P = 0.001) in the patients with CRC. Kaplan–Meier analysis showed 3-year RFS and 3-year OS were significantly worse in the low GNRI group than in high GNRI group (p = 0.001, 0.0037). A low-preoperative GNRI was significantly associated with a poor prognosis in elderly CRC patients.

Prognostic values of geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) in elderly patients with Diffuse Large B-Cell Lymphoma

Background: Geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) are associated with prognosis of various malignancies. Although GNRI and PNI indicates prognosis in some clinical settings, the values of GNRI and PNI on the prognosis of geriatric patients with Diffuse Large B‐Cell Lymphoma (DLBCL) is unclear. This retrospective analysis aimed to explore the prognostic values of GNRI and PNI in elderly DLBCL patients.

Methods: A total of 133 geriatric patients with DLBCL were recruited from Affiliated Hospital of Xuzhou Medical University, and clinicopathological variables were analyzed. X-Tile program, restricted cubic spline (RCS) and time-dependent receiver operating characteristic (ROC) analysis were used to determine optimal cut-off points of GNRI, PNI and other continuous variables; univariate and multivariate Cox proportional hazards analyses were used for variables selection; Kaplan‐Meier curve was utilized to analyze the influence of variables on prognosis; log-rank test was performed for difference evaluation between groups.

Results: The optimal cut-off points for GNRI and PNI were 106.26 and 47 by using RCS. Multivariate analysis showed that PNI, age, hemoglobin, liver invasion and central nervous system invasion were independent prognostic factors for elderly patients with DLBCL, and PNI was (P = 0.001, HR = 0.413, 95% CI (0.240-0.710) a stronger predictor. Low PNI could predict worse prognosis independently of elderly patients of DLBCL and could re-stratify patients in GCB group, CD5 positive group BCL-2 positive group, and BCL-6 positive group.

Conclusions: PNI was an independent adverse factor for elderly DLBCL and patients with low PNI in GCB group, CD5 positive group and BCL-6 positive group were with poor survival.

The comparison of GNRI and other nutritional indexes on short-term survival in geriatric patients treated for respiratory failure

BACKGROUND

There are several screening tools used in the detection of malnutrition to facilitate nutritional support and predict prognosis in the elderly.

AIMS

We aimed to compare the prognostic predictive value of geriatric nutritional risk index (GNRI) with other nutritional indices on 1 month survival in geriatric patients hospitalized for respiratory failure in intensive care unit (ICU).

METHODS

A total of 191 geriatric patients (> 65 years) admitted to a specialized chest hospital with respiratory failure between January 2018 and January 2019 were analyzed. Patients were classified into two category according to 30-day survival: Survivors and Non-survivors. Nutritional assesment was done via GNRI, OPNI, NRS 2002, Nutric Scores in ICU.

RESULTS

Using GNRI, 146 (76.3%) geriatric patients found to be at risk of malnutrition (GNRI score: ≤ 92). GNRI < 86.9 showed significantly higher 30-day mortality rate and patients with malnutrition risk were older, had significantly lower BMI, OPNI, and higher SOFA score. The Age, NRS 2002, Nutric and SOFA score had negative correlation with GNRI. Nutric score, prealbumin and GNRI were detected as significant independent risk factors of 30-day mortality. GNRI had higher sensitivity (76.7%) but lower specificity (57.1%) compared to Nutric score and OPNI for the prediction of 30-day hospital mortality.

CONCLUSIONS

Compared to others, Geriatric Nutritional Risk Index (GNRI) seems to be a good predictor of 30-day mortality and having a score of less than 86.9 increase the malnutrition risk in geriatric patients hospitalized for respiratory failure in ICU.

The Geriatric Nutritional Risk Index as a Prognostic Factor in Patients with Advanced Non-Small-Cell Lung Cancer

The Geriatric Nutritional Risk Index (GNRI) is widely applied as a prognostic factor in different cancers. We aimed to analyze the prognostic value of the GNRI in 257 patients diagnosed with advanced non-small-cell lung cancer (NSCLC). Patients with GNRI >98, 92-98, and <92 were grouped into normal, low risk and moderate/high risk groups, respectively. There were 45.1% patients at risk for malnutrition. Kaplan-Meier survival curves indicated that patients with lower GNRI scores had a poorer overall survival (OS). Two-year OS for normal, low risk and moderate/high risk groups were 57.4%, 42.3% and 15.8%, respectively. In multivariate survival analysis, GNRI (<92), body mass index (BMI, ≥24 kg/m2), combined therapy, hemoglobin and neutrophil-to-lymphocyte ratio (NLR) were independent prognostic factors of OS. Stratifying by age groups, GNRI (<92), hemoglobin and NLR were independent prognostic factors of OS in patients aged <65 years. GNRI (<92), smoking, BMI (≥24 kg/m2) and platelet-to-lymphocyte ratio were independent prognostic factors of OS in patients aged ≥65 years. In conclusion, GNRI was a significant prognostic factor in advanced NSCLC patients regardless of age. A decreased GNRI may be considered as a clinical trigger for nutritional support in advanced NSCLC patients, though additional studies are still required to confirm the best cut-point.

Survival Disparities of Diffuse Large B-Cell Lymphoma in a Community-Based Inner-City Cancer Center

BACKGROUND

Diffuse large B-cell lymphoma (DLBCL) comprises approximately 30% of all non-Hodgkin lymphomas. Multiple studies have demonstrated race-based disparities in survival among patients with DLBCL across all stages of disease, in the era both before and after rituximab. The etiology for the racial disparities in survival among patients with DLBCL is still unknown. Moreover, the Revised International Prognostic Index (R-IPI), a tool that predicts the DLBCL patients' outcome, has not yet been validated in African Americans (AA).

PATIENTS AND METHODS

We conducted a cohort study of patients diagnosed with DLBCL from January 1, 2007, to December 31, 2017, from our tumor registry in a single community-based inner-city cancer center. We abstracted demographic, clinical, histopathologic, treatment, and R-IPI variables. A total of 181 patients (47.5%) with biopsy-proven DLBCL were included in the retrospective analysis. The median age was 65 years, 47% were men, 41% were AA, and 44% were white.

RESULTS

The AA group had a younger median age, higher lactate dehydrogenase levels, higher frequency of B symptoms, and higher HIV infection than the non-AA group. The AA group had significantly decreased median overall survival than the non-AA group (15.7 months; 95% confidence interval, 10.3 to 23.9, vs. 93.6 months; 95% confidence interval, 61.5 to 142.6, respectively; P < .001). The survival disparities persisted after excluding patients with HIV and who did not receive chemotherapy. In addition, AA race predicts a reduced survival by univariate and multivariate analysis.

CONCLUSION

AA with DLBCL may have a poorer prognosis than the non-AA population. Further studies should investigate the biology of DLBCL in the AA population.

Validation and comparison of prognostic values of GNRI, PNI, and CONUT in newly diagnosed diffuse large B cell lymphoma

Diffuse large B cell lymphoma (DLBCL) is the most common type of aggressive non-Hodgkin lymphoma. Emerging evidence indicates that poor nutritional status determined with nutritional indices such as geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status score (CONUT) was associated with poor prognosis of DLBCL. We conducted this multicenter retrospective study to validate and compare prognostic values of the three indices in 615 newly diagnosed DLBCL patients. The overall survival (OS) in patients with poor nutritional status determined with each of these nutritional indices were significantly inferior compared with that in those without nutritional risks (5-year OS in patients with GNRI < 95.7 and GNRI ≥ 95.7 were 56.4% and 83.5%, P < 0.001; PNI < 42.4 and PNI ≥ 42.4 were 56.1% and 81.0%, P < 0.001; CONUT > 4 and CONUT ≤ 4 were 53.1% and 77.1%, P < 0.001). GNRI and CONUT were independent prognostic predictors for OS (GNRI < 95.7, hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.22-2.74, P = 0.0032; CONUT > 4, HR 1.53, 95% CI 1.05-2.23, P = 0.028) after multivariate analyses. Nutritional status determined with GNRI affected OS more strongly in the patients with nongerminal center B cell-like (nonGCB) DLBCL compared with that in those with GCB-type DLBCL. In conclusion, baseline poor nutritional status determined based on GNRI or CONUT was an independent risk factor of newly diagnosed DLBCL, and GNRI was also useful as an independent prognostic factor for patients with nonGCB-type DLBCL.

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

BACKGROUND

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).

PATIENTS AND METHODS

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 (<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.

RESULTS

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 (n [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 (p < 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.

CONCLUSIONS

For mUC patients receiving second-line PEM therapy, the GNRI is a useful predictive biomarker for survival outcome.

Clinical impact of controlling nutritional status score on the prognosis of patients with diffuse large B-cell lymphoma

The controlling nutritional status (CONUT) score is a nutritional index calculated from serum albumin and total cholesterol levels and lymphocyte counts. Its role in predicting clinical outcomes of diffuse large B-cell lymphoma (DLBCL) has not been evaluated. In this retrospective study, data from 476 patients with DLBCL were analyzed. The cutoff value of the CONUT score was set as 4. CONUT score significantly stratified the overall survival (OS) and the progression-free-survival (PFS) (5-year OS, 49.0% vs 83.2%, P < .001; 5-year PFS, 46.1% vs 73.1%, P < .001) of the patients. Among patients at high-intermediate or high risk, as per the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI), 5-year OS was lower in patients with high CONUT scores than in those with low CONUT scores (high-intermediate risk, 51.2% vs 75.5%, P < .001; high risk, 29.9% vs 63.3%, P = .007). Additionally, in patients with high CONUT scores, maintenance of relative dose intensity (RDI) of chemotherapy did not affect the 5-year OS (RDI > 80% vs RDI ≤ 80%: 59.8% vs 50.9%, P = .73). In the present study, we have demonstrated that the CONUT score is an independent prognostic factor in patients with DLBCL.

Prognostic model based on the geriatric nutritional risk index and sarcopenia in patients with diffuse large B-cell lymphoma

Background

Systemic inflammation and cachexia are associated with adverse clinical outcomes in diffuse large B-cell lymphoma (DLBCL). The Geriatric Nutritional Risk Index (GNRI) is one of the main parameters used to assess these conditions, but its efficacy in DLBCL is inconclusive.

Methods

We retrospectively reviewed 228 DLBCL patients who were treated with R-CHOP immunochemotherapy (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone). The patients were stratified according to GNRI score (> 98, 92 to 98, 82 to < 92, and < 82) as defined in previous studies. Additionally, the extent of sarcopenia was categorized as sarcopenia-both, sarcopenia-L3/PM alone, and non-sarcopenia-both according to skeletal muscle index.

Results

Survival curves plotted against a combination of GNRI and sarcopenia scores revealed two clear groups as follows: high cachexia risk (HCR) group (GNRI < 82, sarcopenia-both, or GNRI 82–92 with sarcopenia-L3/PM alone) and low cachexia risk (LCR) group (others). The HCR group had a lower complete response rate (46.5% vs. 86.6%) and higher frequency of treatment-related mortality (19.7% vs. 3.8%) and early treatment discontinuation (43.7% vs. 8.3%) compared with the LCR group. The median progression-free survival (PFS) (not reached vs. 10.3 months, p <  0.001) and overall survival (OS) (not reached vs. 12.9 months, p <  0.001) were much shorter in the HCR group than in the LCR group. On multivariable analyses, the HCR group was shown to be an independent negative prognostic factor for PFS and OS after adjusting the National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI).

Conclusions

A combined model of GNRI and sarcopenia may provide prognostic information independently of the NCCN-IPI in DLBCL.

GNRI as a Prognostic Factor for Outcomes in Cancer Patients: A Systematic Review of the Literature

Oncologic patients often suffer from malnutrition which in turn, might have negative impact on treatment outcomes. The Geriatric Nutritional Risk Index (GNRI), as an index of impaired nutritional status, has emerged as a significant prognostic factor for short-and long-term outcomes in cancer patients. The aim of the current systematic review is to determine whether the GNRI is an independent prognostic factor of postoperative complications and survival in cancer patients. A systematic search was conducted to identify studies, published from 2005 to 2019, which assessed associations between GNRI and short- and long-term outcomes in cancer patients. Eighteen studies fulfilled the eligibility criteria and were included in the analysis. Low scores of GNRI were associated with increased risk for developing postoperative complications and impaired survival of cancer patients in most studies. Our findings support the use of the GNRI in the clinical practice, since it is a simple and reliable tool for assessing nutritional status in oncologic patients. More prospective, multi-centered studies are warranted to confirm the current results, as well as the role of nutritional support in improving the prognosis of cancer patients.

Geriatric Nutritional Risk Index Predicts Adverse Outcomes in Human Malignancy: A Meta-Analysis

Background

Geriatric Nutritional Risk Index (GNRI) has been widely used to assess the nutritional status in a variety of human pathological conditions, but the prognostic value of the GNRI in malignancies has not been evinced.

Methods

Relevant studies updated on Jul 27, 2019, were retrieved in available databases, including PubMed, Web of Science, Cochrane library, Chinese CNKI, and Chinese Wan-fang. Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted and pooled by using STATA 14.

Results

A total of 15 studies involving 8,046 subjects were included in this meta-analysis. Meta-analysis results evinced that low GNRI was associated with poor OS (HR = 1.95, 95% CI: 1.49-2.56, p ≤ 0.001), poor CSS (HR = 1.81, 95% CI: 1.49-2.19, p ≤ 0.001), poor DFS (HR = 1.67, 95% CI: 1.28-2.17, p ≤ 0.001), and poor PFS (HR = 1.68, 95% CI: 1.28-2.21, p ≤ 0.001), and the correlation of GNRI with OS was not changed when stratified by possible confounding factors, suggesting that malignancy patients with low GNRI would suffer from reduced survival rate and increased recurrence rate. Moreover, low GNRI was also associated with postoperative complications in malignancies.

Conclusions

In summary, GNRI is associated poor prognosis in human malignancies, and GNRI should be used as a predictive indicator of adverse outcomes during malignancy treatment.

The effect of malnutrition on mortality in hospitalized patients with hematologic malignancy

OBJECTIVES

The aim of this study was to assess the association between malnutrition status with the (Global Leadership Initiative on Malnutrition) GLIM criteria and 1-year mortality in hospitalized patients with hematologic malignancy.

METHODS

This study included 120 hospitalized patients with hematologic malignancy. Patients who were at risk of malnutrition with NRS2002 were reevaluated with the GLIM criteria for defined malnutrition. Also, the mid-upper arm circumference (MUAC), calf circumference (CC), and handgrip (HG) were measured, and albumin, C reactive protein (CRP), and total protein were recorded to assess malnutrition-related factors.

RESULTS

A total of 120 patients are with lymphoma, leukemia, and myeloma having a rate of 34.2%, 34.2%, and 31.6%, respectively, and risk of malnutrition with NRS2002 was established in 82% of patients. Malnutrition with GLIM criteria was seen in 25.8% of patients. The 1-year mortality rate was 41.7% (n = 50). Malnutrition was associated with higher mortality risk independently with age and duration of diagnosis (HR 3.55 (1.99-6.34), p = 0.001). Low HG (HR 0.51 (0.26-0.99), p = 0.03), low albumin (HR 0.39 (0.2-0.6), p = 0.001), and high CRP (HR 2.39 (1.36-4.20), p = 0.002) were significantly associated with increased mortality risk. In contrast, BMI, MUAC, FFMI, and CC were not associated with higher mortality.

CONCLUSION

Malnutrition is high with the GLIM criteria. Hospitalized patients with hematologic malignancy with malnutrition have a higher 1-year mortality risk.