ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1598043
This article is part of the Research TopicNutritional Impacts on Human Tumor Development and Immune SystemView all 9 articles
Predictive Value of Composite Nutritional Indicators Geriatric Nutritional Risk Index and Controlling Nutritional Status for Mortality Risk in Early-Onset Cancer Survivors
Provisionally accepted
- 1The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- 2The Sixth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
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Malnutrition represents a critical determinant of adverse clinical outcomes and substantial disease burden in cancer patients. Despite the established prognostic value of Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status (CONUT) as composite inflammation-immune-nutrition indices in elderly cancer patients, their utility in early-onset (EO) cancer survivors remains unclear.This retrospective study evaluated GNRI and CONUT for predicting mortality in 3,273 early-onset (EO) cancer survivors, with a development cohort (n=2,814) from NHANES (1999-2018) and a validation cohort (n=459) from the Second Affiliated Hospital of Harbin Medical University (2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020). Patients were stratified by GNRI (<98 vs. ≥98) and CONUT (≥2 vs. ≤1) and grouped into composite risk categories: High-risk (GNRI<98+CONUT≥2), Moderate-risk (GNRI<98+CONUT≤1 or GNRI≥98+CONUT≥2), and Low-risk (GNRI≥98+CONUT≤1).In the development cohort, GNRI<98 and CONUT≥2 independently predicted elevated risks of all-cause mortality (HR=3.36, 95%CI=2.69-4.19, P<0.001), cancer-specific mortality, and non-cancer mortality. High-risk patients exhibited the poorest survival outcomes compared to Low-risk (all-cause mortality HR=3.36, P<0.001). Kaplan-Meier analysis confirmed worse prognosis in GNRI<98, CONUT≥2, and High-risk groups across all mortality endpoints. Validation cohort results aligned with these findings, reinforcing the prognostic significance of composite nutritional risk stratification.This study is the first to validate GNRI and CONUT as effective composite inflammation-immune-nutrition indices for identifying high-risk EO cancer survivors. Composite stratification combining both indices enhances multidimensional inflammation-immune-nutrition risk assessment, offering a practical framework for prognostication and personalized care in this population.
Keywords: GNRI, CONUT, nutrition, early-onset cancer, Infl ammation
Received: 22 Mar 2025; Accepted: 14 Jul 2025.
Copyright: © 2025 Li, Mou, Yu, Zhang, Qi and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wenyang Li, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
Guiyu Wang, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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