Prognostic role of geriatric nutritional risk index (GNRI) and controlling nutritional status (CONUT) on outcomes in patients with head and neck cancer: a systematic review and meta-analysis

Abstract

Abstract Background Malnutrition is a common comorbidity in patients with head and neck cancer (HNC), significantly impacting survival rates. The Geriatric Nutritional Risk Index (GNRI) and the Controlling Nutritional Status (CONUT) score are tools used to assess the nutritional status, yet their prognostic value in HNC remains to be fully established. Methods We performed a systematic review and meta-analysis, adhering to PRISMA guidelines, to evaluate the prognostic significance of GNRI and CONUT on survival outcomes in patients with HNC. Relevant studies up to March 2024 were identified through comprehensive searches of PubMed, EMBASE, and Cochrane CENTRAL databases. The quality of each included study was assessed using the Newcastle-Ottawa Scale. Results Seventeen studies were included, encompassing a total of 3,816 patients with HNC. Our findings reveal that a lower GNRI is consistently associated with poor overall survival (OS, adjusted hazard ratio [aHR]: 3.9, 95% confidence interval [CI]: 2.47–6.14) and progression-free survival (PFS, aHR: 1.76, 95% CI: 1.41–2.21), demonstrating its utility as a prognostic indicator. However, CONUT scores revealed no significant differences in OS (aHR: 1.65, 95% CI: 0.94–2.91) or PFS (aHR: 1.43, 95% CI: 0.68–3.02). Conclusion GNRI appears to be a reliable prognostic tool for predicting poorer survival outcomes in HNC patients, underscoring the importance of nutritional assessments in this population. Further research is needed to clarify the prognostic value of the CONUT score, which exhibited less consistent results.

Keywords

• Geriatric nutritional risk index (GNRI)
• Controlling Nutritional Status (CONUT) score
• Head and neck cancer (HNC)
• Survival
• Meta-analysis
• Nutritional assessment