Geriatric Nutritional Risk Index Predicts Treatment Intolerance and Survival in Head and Neck Cancer

Background Malnutrition is associated with worse outcomes in head and neck cancer (HNC). The geriatric nutritional risk index (GNRI) may predict postoperative morbidity and survival, but its role remains underexplored. Methods An ambispective study of patients undergoing HNC surgery at two academic centers (2015–2024) was performed. Preoperative GNRI was categorized into moderate‐to‐high risk (< 92), low risk (92–98), and no risk (> 98). Outcomes included 90‐day mortality, treatment intolerance, overall survival, and disease‐free survival. Analyses were performed using multivariable logistic and Cox regression adjusted for age, Charlson Comorbidity Index (CCI), tumor stage, primary tumor site, and percutaneous endoscopic gastrostomy (PEG) status. Patients with prior head and neck cancer or prior radiation were excluded. Results Among 312 treatment‐naïve surgical patients, 13% were moderate‐to‐high GNRI risk and 8% low risk. Moderate‐to‐high GNRI risk had higher major adverse events (57% vs. 36% in no‐risk), greater treatment intolerance (61% vs. 41%), and a trend toward higher 90‐day mortality (11% vs. 4%). On multivariable models adjusted for tumor site and pathologic stage, moderate‐to‐high GNRI risk was associated with higher odds of 90‐day mortality (OR 2.99, 95% CI 1.01–9.31; p = 0.048) and treatment intolerance (OR 2.35, 95% CI 1.21–4.56; p = 0.012). Cox regression showed shorter overall (HR 2.28, 95% CI 1.44–3.62; p < 0.001) and disease‐free survival (HR 1.87, 95% CI 1.20–2.91; p = 0.005). Conclusions The GNRI predicted treatment intolerance and poorer survival in patients with operable HNC.