Optimizing the Clinical Utilization of Geriatric Nutritional Risk Index in Esophageal Squamous Cell Carcinoma Treated with Neoadjuvant Immunochemotherapy

We have carefully read the paper titled 'Clinical significance of geriatric nutritional risk index in esophageal squamous cell carcinoma receiving neoadjuvant immunotherapy' published in the European Journal of Surgical Oncology by Feng et al. presents a well-executed single-center retrospective cohort study [ 1 Feng J. Wang L. Yang X. Chen Q. Cheng X. Clinical significance of geriatric nutritional risk index in esophageal squamous cell carcinoma receiving neoadjuvant immunotherapy. Eur J Surg Oncol. 2024; 6108323 Google Scholar ]. The authors aimed to assess the clinical relevance of the geriatric nutritional risk index (GNRI) in esophageal squamous cell carcinoma (ESCC) patients receiving neoadjuvant immunochemotherapy. A total of 224 ESCC cases were retrospectively reviewed, with patients divided into low GNRI (n=139) and high GNRI (n=85) groups. Results indicated that higher GNRI levels were linked to increased rates of pathological complete response (pCR) after surgery, lower postoperative complications, and improved overall survival (OS) and disease-free survival (DFS) rates. Specifically, patients in the high GNRI group exhibited higher pCR rates, lower severe morbidity, and better 3-year OS and DFS compared to those in the low GNRI group. GNRI was identified as an independent predictor for both DFS and OS. Moreover, the study analyzed the composition of GNRI, patient characteristics based on GNRI, relative dose characteristics, treatment-related adverse events, predictors of pCR and complications, as well as predictors of DFS and OS. The results underscored the prognostic potential of GNRI in predicting outcomes, treatment response, and surgical results, emphasizing its superiority over traditional nutritional indices. Logistic and Cox regression analyses further identified GNRI as a significant independent factor for predicting pCR, postoperative complications, OS, and DFS in ESCC patients undergoing neoadjuvant immunochemotherapy. While the study by Feng and colleagues is insightful, further discussion is warranted on certain aspects. Reply to: "Optimizing the Clinical Utilization of Geriatric Nutritional Risk Index in Esophageal Squamous Cell Carcinoma Treated with Neoadjuvant Immunochemotherapy"European Journal of Surgical OncologyPreviewWe read with interest the letter from Li et al. regarding our recently published article "Clinical significance of geriatric nutritional risk index in esophageal squamous cell carcinoma receiving neoadjuvant immunotherapy" [1]. Concerns were raised by the authors in terms of our findings about the clinical implications of the geriatric nutritional risk index (GNRI) in those with esophageal squamous cell carcinoma (ESCC). We appreciate their feedback and pointing out a few of our responses. Full-Text PDF