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Pretreatment geriatric nutritional risk index is associated with impaired treatment continuity and supportive care–relevant outcomes in unresectable pancreatic ductal adenocarcinoma
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DOI：10.1007/s00520-026-11102-1.png)
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Abstract
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Patients with unresectable pancreatic ductal adenocarcinoma (PDAC) frequently experience impaired treatment continuity, and many cannot reach second-line treatment. We evaluated whether pretreatment geriatric nutritional risk index (GNRI) could identify patients at risk of impaired treatment continuity, treatment-related adverse events, and shorter survival. This single-center retrospective study included 120 patients with unresectable PDAC who initiated first-line chemotherapy. The primary outcome was transition to second-line chemotherapy. Secondary outcomes included overall survival and treatment–related outcomes. Multivariable logistic and Cox regression analyses adjusted for age, performance status, chemotherapy regimen, distant metastasis, ascites, and carbohydrate antigen 19–9. Second-line transition was less frequent in patients with GNRI < 92 than in those with GNRI ≥ 92 (45% vs 80%, P < 0.001). The low-GNRI group had a shorter duration of first-line chemotherapy (4.0 vs 6.9 months; P = 0.001), more frequent discontinuation within 3 months (36% vs 15%; P = 0.012), and higher frequencies of non-biliary non-hematologic adverse events and related hospitalizations. Each 1-point increase in GNRI was independently associated with second-line transition (odds ratio 1.08, 95% confidence interval 1.03–1.14) and longer overall survival (hazard ratio 0.96, 95% confidence interval 0.93–0.98). Pretreatment GNRI was associated with impaired treatment continuity, non-biliary non-hematologic adverse events and related hospitalizations, and shorter survival in unresectable PDAC. These findings support GNRI as a practical screening marker for early nutritional assessment, symptom monitoring, and multidisciplinary supportive care.
Keywords:
Supportive care
Pancreatic cancer
Nutritional status
Geriatric nutritional risk index
Risk stratification
Cachexia
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