Geriatric Nutritional Risk Index Predicts Prognosis of Elderly Gastric Cancer Patients After Non-Curative Endoscopic...

Additional gastrectomy is usually performed after endoscopic submucosal dissection (ESD) for early gastric cancer diagnosed as "non-curative" according to the Japanese guidelines. However, the prognostic benefit of additional gastrectomy for the elderly with non-curative ESD is still debatable. The Geriatric Nutritional Risk Index (GNRI) is known as a prognostic value in elderly patients. This study aimed to clarify the advantages of GNRI as a prognostic indicator for elderly gastric cancer patients with non-curative ESD. A total of 120 elderly patients who underwent ESD for gastric cancer and diagnosed as non-curative resection according to the Japanese guidelines were retrospectively selected from the database of the Kobe University Hospital between January 2008 and March 2020. Their general condition, risk of lymph node metastasis, and nutritional status were evaluated retrospectively, and prognostic analysis was performed. After non-curative ESD, 48 patients underwent additional gastrectomy with lymph node dissection, and 72 patients were followed up with no additional treatment. In the follow-up group, patients with a high risk of lymph node metastasis had a significantly poorer prognosis. However, in the prognostic analysis of 120 cases, additional gastrectomy or follow-up were not independent prognostic factors. In the analysis of the additional gastrectomy group only, major nutrition-related risk of postoperative GNRI was an independent prognostic factor (95% CI: 0.01-0.25, P < 0.001). In elderly, the GNRI may be helpful as a prognostic indicator. Especially for elderly patients with poor nutritional status, additional gastrectomy might be considered only in cases of high risk of recurrence after non-curative ESD.