30Association between Postoperative GNRI and Chemotherapy Dose Intensity with Survival Outcomes in Biliary Tract Cancer
Jin Ho Choi, Tae Seung Lee, Chang Hyun Kim, Eun Jeong Kim, In Rae Cho, Woo Hyun Paik, Ji Kon Ryu, Sang Hyub LeeAbstract
Background
Biliary tract cancer (BTC) is a heterogeneous and aggressive malignancy with poor prognosis even after curative resection. Although adjuvant chemotherapy is recommended to improve survival, determinants of relative dose intensity (RDI) remain unclear. Nutritional and inflammation-based markers have emerged as objective indicators of systemic inflammation and host immune-nutritional status; however, their prognostic relevance in resected BTC has not been fully elucidated.
Methods
We retrospectively analyzed 172 patients with pathologically confirmed BTC who underwent curative resection followed by adjuvant chemotherapy at Seoul National University Hospital between 2011 and 2023. Postoperative nutritional and inflammation-based indices—including prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammation response index (SIRI), and platelet-to-albumin ratio (PAR)—were evaluated. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using Cox proportional hazards models.
Results
Patients with GNRI ≥98 demonstrated longer RFS (median 45 vs. 21 months, p = 0.135) and significantly improved OS (median 108 vs. 57 months, p = 0.004) compared with those with GNRI <98. In multivariable analysis, OS was independently associated with higher GNRI (hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.36–0.97; p = 0.038), lower PAR (HR 2.23, 95% CI 1.30–3.80; p = 0.003), and higher RDI of adjuvant chemotherapy (HR range 0.31–0.41; all p < 0.007).
Conclusion
Postoperative GNRI, PAR, and RDI were independently associated with OS in patients undergoing curative resection for BTC. These findings underscore the importance of perioperative nutritional assessment and optimization. Systematic nutritional management combined with adequate supportive care may help maintain chemotherapy dose intensity and improve long-term survival outcomes in this population.