Association between Geriatric Nutritional Risk Index and survival outcomes in patients with urological cancers: an updated meta-analysis.

objectivesThis meta-analysis aimed to evaluate the association between the Geriatric Nutritional Risk Index (GNRI) and survival outcomes in patients with urological cancer.

designSystematic review and meta-analysis of observational studies. DATA SOURCES: A comprehensive literature search was conducted in Medline, EMBASE, Google Scholar and the Cochrane Library from inception to 7 July 2024. ELIGIBILITY CRITERIA: Studies were included if they examined the correlation between the GNRI and long-term survival outcomes in adult patients (≥18 years old) with urological cancers. DATA EXTRACTION AND SYNTHESIS: Two researchers independently extracted data and assessed study quality using the Newcastle-Ottawa Scale and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. Publication bias was evaluated using funnel plots and Egger's test for outcomes with more than 10 studies. Pooled HRs and 95% CIs were calculated using a random-effects model. Subgroup analyses, meta-regression and sensitivity analyses were performed.

results17 studies involving 8816 patients were included. Study quality assessment showed that 15 studies had a low risk of bias (scores 7-9) and two had a high risk (scores 5-6). Low GNRI was significantly associated with poor overall survival (OS) (HR: 2.6, 95% CI: 2.0 to 3.38, p<0.00001, I² = 64%, 13 studies), cancer-specific survival (CSS) (HR: 2.65, 95% CI: 1.76 to 3.98, p<0.00001, I² = 75%, 7 studies), recurrence-free survival (RFS) (HR: 1.47, 95% CI: 1.02 to 2.1, p=0.04, I² = 58%, four studies) and progression-free survival (PFS) (HR: 1.86, 95% CI: 1.54 to 2.23, p<0.00001, I² = 0%, five studies). Funnel plot and Egger's test (p=0.948) indicated a low risk of publication bias for OS. GRADE assessment showed low certainty of evidence for OS and PFS, and very low certainty for CSS and RFS. Meta-regression identified follow-up time and sample size as significant sources of heterogeneity.

conclusionsA low GNRI is significantly associated with poor survival outcomes in patients with urological cancer. The GNRI may serve as a valuable prognostic tool in clinical practice. Further research is needed to validate these findings in diverse populations and to explore the underlying biological mechanisms. PROSPERO REGISTRATION NUMBER: CRD42023476678.