Pretreatment geriatric nutritional risk index is associated with impaired treatment continuity and supportive care-relevant outcomes in unresectable pancreatic ductal adenocarcinoma.

PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.