Relationship Between Preoperative Nutritional Risk Index And Erythrocyte Distribution Width In The Elderly And Clinicopathological Characteristics And Prognosis Of Patients With Non-Ⅳ Gastric Cancer

Objective(s):The preoperative geriatric nutritional risk index(GNRI)and red blood cell distribution width(RDW)levels can reflect the nutritional status and inflammatory status in patients with malignant tumors,and are meaningful in assessing malignant tumor progression and overall survival.It has some significance in assessing the progression of malignant tumors and overall survival.However,few studies have been reported on the clinicopathological characteristics and prognostic evaluation of non-IV gastric cancer(GC),and the purpose of this paper is to investigate the predictive value of GNRI and RDW levels in the prognosis of non-IV gastric cancer patients.Methods: To retrospectively analyze the clinical case data of 206 patients with primary non-stage IV gastric cancer admitted to The First Affiliated Hospital of Kunming Medical University from June 2017 to June 2021 with survival follow-up.The subject operating characteristic curve(ROC curve)for GNRI,RDW and both combined to predict the prognosis of gastric cancer was plotted with patients’ survival or death as the outcome,and the optimal critical values of GNRI and RDW were determined as 103.47 and 14%,respectively,according to which they were divided into low GNRI group(GNRI < 103.47),high GNRI group(GNRI ≥ 103.47),low RDW group(RDW < 14)and high RDW group(RDW ≥ 14),and compared the pathological characteristics(tumor location,tumor length,tumor differentiation,vascular invasion,nerve invasion,pathological type,T stage,N stage,pathological stage(p TNM stage)and clinical characteristics between different subgroups.differences in blood routine,blood biochemistry,and tumor markers.The clinical case characteristics that were statistically different between patients in the low GNRI and high GNRI groups were selected and included in a binary logistic regression multifactor analysis model to analyze the factors affecting GNRI values,and the factors affecting RDW values were analyzed in the same way.The correlation between GNRI and RDW levels in patients with gastric cancer was also analyzed.Kaplan-Meier survival curves were plotted to estimate the cumulative survival rates and mean survival times at 1,3,and 5 years for patients in the low GNRI and high GNRI groups,and in the low RDW and high RDW groups,and independent risk factors affecting the prognosis of non-IV gastric cancer were analyzed using univariate and multifactorial Cox regression models.Results: Statistically significant differences in follow-up time,BMI,PNI,NRL,SIRI,absolute neutrophil values,absolute lymphocyte values,absolute monocyte values,haemoglobin,peripheral red blood cells,leucocytes,total protein,globulin,lymph node metastasis rate and number of positive lymph nodes in the different GNRI levels in the measurement data(all P<0.05);The classified information in age,BMI,vascular invasion,postoperative adjuvant chemotherapy,T-stage,pathological stage(p TNM stage)and survival status were statistically significant(P<0.05);the classified information in age,follow-up time,PNI,NRL,absolute lymphocyte value,haemoglobin,peripheral blood erythrocytes and leucocytes in different RDW levels in the categorical data were statistically significant(P<0.05)The classified information in age,tumour length,nerve invasion,postoperative adjuvant chemotherapy,T-stage,N-stage,pathological stage(p TNM stage)and survival status were all statistically significant(P<0.05).Binary logistic regression multi-factor analysis showed that the effects of haemoglobin and T-stage on GNRI were statistically significant(P<0.05);the effects of haemoglobin on RDW were statistically significant(P<0.05).GNRI was negatively correlated with RDW levels in patients with non-stage IV gastric cancer(P < 0.05);survival analysis functions plotted by the Kaplan-Meier model showed that higher GNRI levels(GNRI≥103.47)predicted longer overall survival(P<0.05).Higher levels of RDW(RDW>14)predicted shorter overall survival(P<0.05).Univariate analysis showed that age,tumour length,vascular invasion,nerve invasion,postoperative adjuvant chemotherapy,GNRI,RDW,PNI,T-stage,N-stage,pathological stage(p TNM stage),lymph node metastasis rate and haemoglobin were risk factors affecting OS in patients with non-IV gastric cancer(all P < 0.05);multivariate Cox regression model analysis showed that tumour length,GNRI,lymph node metastasis rate,and T-stage remained independent risk factors affecting OS in patients with non-IV gastric cancer(P<0.05).Conclusion(s):1.Lower GNRI and higher RDW levels may be risk factors affecting the overall survival of patients with non-IV gastric cancer.2.Combined detection of GNRI and RDW levels may have some reference value in predicting the overall survival of patients with non-IV gastric cancer.3.GNRI and RDW levels in non-IV gastric cancer patients may reflect the tumour load,inflammation and nutritional status of the body.4.GNRI and RDW levels in non-stage IV gastric cancer patients were negatively correlated.