The prognostic value of prognostic nutritional index in advanced cancer receiving PD‐1/L1 inhibitors: A meta‐analysis

Abstract

Purpose To study the prognostic value of the prognostic nutritional index (PNI) in advanced cancers receiving programmed death‐1/programmed death‐ligand 1 (PD‐1/L1) inhibitors. Methods Online electronic databases were comprehensively searched and available literature was retrieved. We extracted available data from included researches and pooled the hazard ratios (HRs) and 95% confidence intervals (CIs) to learn the prognostic value of PNI on overall survival (OS) or progression‐free survival (PFS); and meanwhile calculated the relative risk (RR) with 95% CI to study the relationship between PNI and treatment efficacy (objective response rate [ORR] or disease control rate [DCR]) in late staged cancer receiving PD‐1/L1 inhibitors. Results Nine studies were finally selected for this meta‐analysis. We obtained data regarding PNI on OS from all nine studies, and the pooled HR was 2.31 (95% CI 1.81–2.94, p = 0.000), showing a correlation between low PNI and worse OS. Eight studies reported a relationship between PNI and PFS, and combined results revealed shorter PFS in patients with lower PNI, with an HR of 1.75 (95% CI 1.40–2.18, p = 0.000). Four studies explored the association between PNI and ORR and two studies explored the influence of PNI on DCR. An association between PNI and ORR (RR = 0.47, p = 0.003) was observed, while no association between PNI and DCR (RR = 0.49, p = 0.103) was observed by pooling these studies. Conclusion In summary, this meta‐analysis indicated that a lower PNI was significantly correlated with decreased OS and PFS and played adverse roles in ORR in advanced cancer patients receiving PD‐1/L1 inhibitors. Therefore, PNI could be promising for predicting prognosis and treatment response in advanced malignancies treated with PD‐1/L1 inhibitors.

Clinical utility of inflammatory and nutritious index as therapeutic prediction of nivolumab plus ipilimumab in advanced NSCLC

“…In a recent meta-analysis, a low PNI signi cantly predicted worse PFS and OS and adversely affected the ORR in patients with advanced cancers who received PD-1 blockade treatment [21]. In these patients, the PNI was an excellent predictor when compared with other indices.…”

Clinical Utility of Inflammatory and Nutritious Index as Therapeutic Prediction of Nivolumab plus Ipilimumab in Advanced Non-Small Cell Lung Cancer

“…In a recent meta-analysis, a low PNI significantly predicted worse PFS and OS and adversely affected the ORR in patients with advanced cancers who received PD-1 blockade treatment [21]. In these patients, the PNI was an excellent predictor when compared with other indices.…”

Pretreatment “prognostic nutritional index” as an indicator of outcome in lung cancer patients receiving ICI-based treatment: Systematic review and meta-analysis

“…[9,10,[25][26][27][28][58][59][60][61] Studies have also looked at the relationship between PNI and immunotherapy and have found PNI to be an independent factor in the prognosis of immunotherapy patients. [29,62] Compared to other indicators, PNI is more suitable for the prediction of survival in the elderly and in patients with malignancies because it considers nutritional status and immunological status. These 2 groups of patients often have poorer nutritional status due to chemotherapy or receipt of surgery.…”

“…[ 9 ] Other studies examined use of the PNI to predict outcome in cancer patients receiving an ICI-based therapy and concluded that a high PNI predicted a better outcome. [ 29 ]…”

“…[9] Other studies examined use of the PNI to predict outcome in cancer patients receiving an ICI-based therapy and concluded that a high PNI predicted a better outcome. [29] We identified 8 retrospective studies, all published since 2019, that examined use of the pretreatment PNI in predicting the outcome of lung cancer patients receiving ICI-based therapies. However, the conclusions of these studies were inconsistent.…”