The geriatric nutritional risk index as a predictor of outcomes in urological cancers: A systematic review and meta-analysis.

Objective: The geriatric nutritional risk index (GNRI) is being used to predict outcomes of several malignancies. However, its utility for urinary tract cancer has not been systematically analyzed. We present the first meta-analysis examining the association between GNRI and the prognosis of urological cancers.

Methods: This PROSPERO registered review searched Embase, PubMed, Web of Science, and Scopus up to 25th November 2024 for studies examining the relationship between GNRI and overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) after urological cancers.

Results: A total of 20 studies were eligible. Three studies on bladder cancer, four on prostate cancer, seven on renal cell carcinoma (RCC), and six on urothelial cancers. Meta-analysis showed that low GNRI was a statistically significant predictor of poor OS in prostate cancer (OR: 3.02 95% CI: 1.61, 5.67). Pooled analysis showed that low GNRI was associated with poor OS (OR: 2.17 95% CI: 1.46, 3.22) and CSS (OR: 2.60 95% CI: 1.57, 4.30) in RCC but not PFS (OR: 1.50 95% CI: 1.00, 2.24). Pooled analysis also found that low GNRI was a predictor of worse OS (OR: 2.24 95% CI: 1.52, 3.29) and CSS (OR: 3.07 95% CI: 1.38, 6.86) in urothelial carcinoma. A narrative review on bladder cancer and GNRI showed mixed results.

Conclusions: GNRI may have a role in predicting outcomes of urological malignancies. Low GNRI was independently associated with worse OS after prostate, renal cell, and urothelial carcinoma. Further, it also predicted CSS after RCC and urothelial carcinoma.