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Low PNI and GNRI correlate with poorer survival in elderly patients with early gastric cancerNutritional status helps predict survival for elderly gastric cancer patients

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Key Takeaway
Note that low PNI (HR 2.91) and lower GNRI (pooled estimate 2.87) are associated with poorer survival in elderly gastric cancer patients.

This systematic review and meta-analysis evaluated the prognostic value of nutritional indices in 1,453 elderly patients (aged 65 years or older) with early gastric cancer treated with endoscopic submucosal dissection. The analysis focused on two specific markers: Prognostic Nutritional Index (PNI) and Geriatric Nutritional Risk Index (GNRI).

The meta-analysis found that low PNI was associated with a significantly higher risk of mortality (HR 2.91; 95% CI 2.12 to 3.99). Additionally, lower GNRI scores were associated with poorer survival outcomes (pooled estimate 2.87; 95% CI 1.36 to 6.02). These findings suggest that nutritional status may serve as a significant indicator of prognosis in this specific population.

Authors noted that further prospective studies are required to validate the clinical utility of these indices and to determine if targeted interventions can modify patient outcomes. Because these results are based on observational data, they indicate an association rather than a causal link between nutrition and survival. These tools may help clinicians stratify risk for elderly patients undergoing endoscopic submucosal dissection.

When an older adult is diagnosed with early gastric cancer, their overall health and nutrition play a massive role in how they handle treatment. Doctors are looking for better ways to predict who might struggle more after surgery. This study looked at 1,453 elderly patients over 65 years old who underwent a specific type of endoscopic surgery to remove early stomach cancer.

Researchers found that two specific nutritional scores, known as PNI and GNRI, are linked to survival outcomes. Patients with low PNI scores had a much higher risk of death compared to those with better scores. Similarly, patients with lower GNRI scores also showed poorer survival results. These numbers suggest that a patient's nutritional status is a significant signal for their long-term health.

While these findings are helpful for identifying high-risk patients, it is important to remember that this was not a clinical trial. The study shows a link between nutrition and survival, but it does not prove that changing a person's diet will automatically improve their outcome. More research is still needed to see if specific nutritional interventions can change the course of the disease.

What this means for you:
Specific nutritional markers help doctors identify higher risks for elderly patients with early stomach cancer.

Common questions

How does nutrition affect the outlook for elderly patients with stomach cancer?

Patients over 65 with early gastric cancer who have lower nutritional scores, specifically PNI and GNRI, were associated with poorer survival. These markers help doctors identify which patients might face a higher risk of mortality after their procedure.

What are the specific nutritional risks for these patients?

The study found that a low PNI score was linked to a much higher risk of death. Additionally, a lower GNRI score was associated with worse survival outcomes for elderly patients undergoing endoscopic submucosal dissection.

Does this mean nutritional supplements will cure the cancer?

No, this study only shows an association between nutrition and survival. It does not prove that a specific nutritional intervention will improve outcomes or cure the disease. You should talk to your doctor about how these findings apply to your specific care.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
BackgroundNutritional risk and host vulnerability may influence long-term outcomes in elderly patients with early gastric cancer (EGC) undergoing endoscopic submucosal dissection (ESD). The prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) are simple nutritional and prognostic indices, but their prognostic value in this population has not been systematically evaluated.MethodsWe conducted a systematic review and meta-analysis of studies assessing the association between PNI or GNRI and long-term survival in elderly patients (≥ 65 years) treated with ESD for EGC. PubMed, Embase, and Web of Science were searched up to December 28, 2025. Hazard ratios (HRs) or comparable multivariable estimates with 95% confidence intervals (CIs) were synthesized using fixed- or random-effects models. Subgroup and sensitivity analyses were conducted to assess consistency and heterogeneity.ResultsSeven studies involving 1,453 elderly patients were included. Low PNI was associated with poorer overall survival (pooled HR 2.91, 95% CI 2.12–3.99), with low heterogeneity. Lower GNRI was also associated with poorer survival outcomes (pooled estimate 2.87, 95% CI 1.36–6.02). Subgroup and sensitivity analyses supported the direction and robustness of the association for PNI.ConclusionLower PNI and GNRI were associated with poorer survival outcomes in elderly patients with EGC treated by ESD. These findings highlight the potential clinical relevance of nutritional risk assessment and may help inform risk stratification, but further prospective studies are needed to validate their clinical utility and assess whether targeted interventions can modify outcomes.Systematic review registrationidentifier: CRD420251270408.
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