Prognostic Value of Pre-Treatment Prognostic Nutritional Index in Esophageal Cancer: A Systematic Review and Meta-Analysis

Abstract

Background: Prognostic nutritional index (PNI), combining albumin and lymphocyte counts, which represent the nutritional and immune status, was considered as an effective predictor for the patient's prognosis after surgery. To comprehensively analyze the relative effectiveness of prognostic performance of pretreatment PNI in esophageal cancer (EC), we performed this meta-analysis.Methods: We performed a systematic search in PubMed, Embase, CNKI, and Web of Science. The hazard ratios (HRs) or odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were extracted to explore the correlation between PNI and the post-operative survival of patients with EC, including overall survival (OS), recurrence-free survival (RFS), and post-operative complications. The Newcastle-Ottawa Scale (NOS) was applied to estimate the quality of the included studies. The Begg's test was applied to assess the publication bias.Results: A total of 13 articles with 3,543 patients, were included in our meta-analysis, and nine studies reported OS in 2,731 EC patients. The pooled results of the nine studies suggested that EC patients with a low PNI would have a worse overall survival (HR = 1.14, 95% CI 0.99-1.31, p < 0.05). The integrated results also indicated that the PNI was a negative predictor for RFS. Conclusion:This meta-analysis indicated a high correlation between PNI and post-operative survival of EC. EC patients with low PNI values tend to have worse OS and may be at a higher risk of EC recurrence. However, more relevant researches are needed to confirm the association between PNI and post-operative complications of EC.

Prognostic Nutritional Index (PNI) in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy as a Useful Prognostic Indicator

“…The mechanism by which a low nutritional status decreases the survival time of breast cancer patients is still not sufficiently understood. The PNI, as a systemic immune–nutrition index based on the peripheral lymphocyte count and serum albumin levels, represents the immune and nutritional status and is also a significant biomarker for many tumors ( Dai et al, 2020 ; Hao et al, 2020 ; Zhang et al, 2020 ). The PNI was initially developed to evaluate the postoperative complications in patients who received gastrointestinal surgery ( Onodera et al, 1984 ).…”

Long-term and short-term prognostic value of the prognostic nutritional index in cancer: a narrative review

“…The authors found that low PNI was correlated with male sex (19,20), old age (19), positive lymph node status (20), advanced T stage (19,20), and body mass index (BMI) (20), but not metastasis (19) or the differentiation grade (19,20) of EC. Meanwhile, another study found that patients with low PNI were at high risk of postoperative complications (21). In a subgroup analysis, the pooled HR was found to be statistically significant across different groups (e.g., country, year of publication, sample size, cutoff value, and quality scores) (19,20).…”

“…Three systematic reviews and meta-analyses have examined the prognostic value of PNI in EC, irrespective of histological type and treatment (19)(20)(21). Most of the included studies were identical, and thus the findings are similar.…”

Prognostic Value of Pretreatment Prognostic Nutritional Index in Patients With Renal Cell Carcinoma: A Meta-Analysis

“…PNI reflects the nutritional and immunologic status of patients with cancer and is a prognostic factor in several solid tumors ( 9 ). Low PNI is associated with poor prognosis in some cancers, such as pancreatic ( 10 ), lung ( 11 ), esophageal cancer (EC) ( 12 ), and ovarian ( 13 ) cancers, and nasopharyngeal carcinoma ( 14 ). Many studies have also explored the prognostic significance of PNI in patients with RCC; however, the results have been inconsistent ( 15 – 24 ).…”