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Purpose <p>Frailty and malnutrition, which are common in older adult patients with colorectal cancer (CRC), adversely affect outcomes. Although the Geriatric Nutritional Risk Index (GNRI) and the Modified Frailty Index (mFI-5) are established tools, their combined predictive value for postoperative complications remains unclear. Therefore, we investigated whether their combination improved risk prediction.</p> Methods <p>We analyzed 399 CRC ≥ 65 years of age who underwent curative surgery. Preoperative assessment included frailty (mFI-5 ≥ 2) and nutritional risk (GNRI &lt; 98). Patients were stratified into low- (no factors), intermediate- (one factor), and high-risk (both factors) groups. Clavien–Dindo grade ≥ II complications were analyzed by multivariate logistic regression to identify predictive factors.</p> Results <p>Infectious complications increased significantly across the low-, intermediate-, and high-risk groups (13.3%, 14.6%, and 30.2%, respectively), with overall complication rates of 20.7%, 22.2%, and 45.3%, respectively. The median postoperative stay increased with increased risk (12, 14, and 18 days, respectively). Anastomotic leakage was more frequent, though not to a statistically significant extent, in high-risk patients. High-risk status independently predicted infectious and overall complications.</p> Conclusions <p>Combined GNRI and mFI-5 assessments facilitated effective stratification of postoperative risk in older adults with CRC. These assessments may help in routine preoperative evaluations and support individualized perioperative care.</p>

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Preoperative risk assessment using GNRI and mFI-5 enhances prediction of postoperative complications in older adults with colorectal cancer

  • 期刊论文

  • 发表日期：

    2025年11月19日

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  • Kazushi Hara,
  • Shoichi Urushibara,
  • Satoshi Nagai,
  • Hiroshi Watanabe,
  • Sadamu Takahashi,
  • Yasuro Kurisu

摘要

Purpose

Frailty and malnutrition, which are common in older adult patients with colorectal cancer (CRC), adversely affect outcomes. Although the Geriatric Nutritional Risk Index (GNRI) and the Modified Frailty Index (mFI-5) are established tools, their combined predictive value for postoperative complications remains unclear. Therefore, we investigated whether their combination improved risk prediction.

Methods

We analyzed 399 CRC ≥ 65 years of age who underwent curative surgery. Preoperative assessment included frailty (mFI-5 ≥ 2) and nutritional risk (GNRI < 98). Patients were stratified into low- (no factors), intermediate- (one factor), and high-risk (both factors) groups. Clavien–Dindo grade ≥ II complications were analyzed by multivariate logistic regression to identify predictive factors.

Results

Infectious complications increased significantly across the low-, intermediate-, and high-risk groups (13.3%, 14.6%, and 30.2%, respectively), with overall complication rates of 20.7%, 22.2%, and 45.3%, respectively. The median postoperative stay increased with increased risk (12, 14, and 18 days, respectively). Anastomotic leakage was more frequent, though not to a statistically significant extent, in high-risk patients. High-risk status independently predicted infectious and overall complications.

Conclusions

Combined GNRI and mFI-5 assessments facilitated effective stratification of postoperative risk in older adults with CRC. These assessments may help in routine preoperative evaluations and support individualized perioperative care.