Table_6_Association of Modified Geriatric Nutrition Risk Index and Handgrip Strength With Survival in Cancer: A Multi-Centre Cohort Study.DOCX

BackgroundThis study aimed to explore the value of combining the modified geriatric nutrition risk index (mGNRI) and handgrip strength (HGS) in the prognosis assessment of cancer.
MethodsThis multicenter, prospective cohort study, enrolled 5,607 cancer patients from 27 medical centers across 17 provinces in China between June 2012 and December 2019. The primary outcome was overall survival. Secondary outcomes included the Karnofsky Performance Scale (KPS) score, Patient-Generated Subjective Global Assessment (PG-SGA) score, cachexia, and admission 90-day outcome. A composite prognostic score (mGNRI-HGS score) was developed based on the mGNRI and HGS. The Kaplan–Meier method was used to draw the survival curve, and log-rank analysis was used to estimate the survival rate. The Cox proportional hazards model was used to investigate the associations of the mGNRI, HGS or mGNRI-HGS score with risk of mortality among the cancer patients, adjusted for potential confounders.
ResultsA low mGNRI (HR = 0.99, 95%CI = 0.98–0.99, p < 0.001) and low HGS (HR = 0.99, 95%CI = 0.98–0.99, p = 0.001) were associated with an increased risk of mortality. A severe mGNRI-HGS score was independently associated with reduced survival. Compared with patients with normal scores, the risk of mortality among the patients with moderate and severe mGNRI-HGS scores was 28.8 and 13.3% higher, respectively. Even within the same pathological stage, it presented significant gradient prognostic stratification. Additionally, a low mGNRI-HGS score was also independently associated with a higher risk of low KPS (p < 0.001), high PGSGA (p < 0.001), cachexia (p < 0.001), and adverse admission 90-day outcome (p < 0.001).
ConclusionsThe mGNRI and HGS may be useful predictors of long-term prognosis in cancer patients. The combination of the two methods provides effective prognostic stratification for cancer patients and could predict physical frailty, malnutrition, and cachexia.

背景：本研究旨在探索改良老年营养风险指数（modified geriatric nutrition risk index, mGNRI）与握力（handgrip strength, HGS）联合应用于癌症预后评估的价值。
方法：本项多中心前瞻性队列研究于2012年6月至2019年12月期间，纳入了中国17个省份27家医疗中心的5607例癌症患者。本研究的主要结局为总生存期；次要结局包括卡氏功能状态评分（Karnofsky Performance Scale, KPS）、患者主观整体评估（Patient-Generated Subjective Global Assessment, PG-SGA）评分、恶病质以及入院后90天结局。研究基于mGNRI与HGS构建了复合预后评分（mGNRI-HGS评分）。采用Kaplan–Meier法绘制生存曲线，通过log-rank检验估计生存率；采用Cox比例风险模型分析癌症患者的mGNRI、HGS或mGNRI-HGS评分与死亡风险的关联，并校正潜在混杂因素。
结果：低mGNRI（风险比HR=0.99，95%置信区间CI=0.98~0.99，p<0.001）与低HGS（HR=0.99，95%CI=0.98~0.99，p=0.001）均与死亡风险升高相关。高mGNRI-HGS评分独立关联于更差的生存期。与评分正常的患者相比，中度和重度mGNRI-HGS评分患者的死亡风险分别升高28.8%和13.3%。即使在同一病理分期中，该评分也呈现出显著的梯度预后分层效应。此外，低mGNRI-HGS评分还独立关联于更低的KPS评分（p<0.001）、更高的PG-SGA评分（p<0.001）、恶病质（p<0.001）以及不良的入院后90天结局（p<0.001）。
结论：mGNRI与HGS可作为癌症患者长期预后的有效预测指标。二者联合可为癌症患者提供有效的预后分层，同时可预测机体衰弱、营养不良及恶病质的发生风险。