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The prognostic significance of the prognostic nutritional index in cancer: a systematic review and meta-analysis

  • Review - Clinical Oncology
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Abstract

Purpose

The prognostic nutritional index (PNI) is a simple and effective parameter, initially created to evaluate preoperative nutritional conditions and surgical risk. It has been recently been found to be associated with short- and long-term outcomes of various malignancies. We performed a meta-analysis to determine the predictive significance of PNI in cancer, as a mean to assist in determining the optimal surgery timing and in improving the survival of cancer patients.

Methods

Data were retrieved from PubMed and ISI Web of Science to identify eligible studies. Odds ratios (ORs) and hazard ratios (HRs) were extracted and pooled to explore the relationships of PNI with patient survival and clinicopathological features.

Results

Fourteen studies with a total of 3,414 participants met the inclusion criteria. Low PNI was associated with poor overall survival (pooled OR 1.80, 95 % confidence interval [CI] 1.59–2.04) and the presence of post-operative complications (pooled OR 2.45, 95 % CI 1.31–4.58) in cancer patients, but not with cancer-specific survival (CSS) (pooled HR 1.81, 95 % CI 0.94–3.49). PNI was also found to be associated with invasion depth (pooled OR 5.07, 95 % CI 2.34–10.96) and lymph node metastasis (pooled OR 3.70, 95 % CI 2.32–5.92) in gastric cancer, whereas TNM stage was the only clinicopathological feature associated with PNI in colorectal carcinoma (pooled OR 1.81, 95 % CI 1.24–2.64).

Conclusions

PNI might be an effective predictive indicator for the prognosis of cancer, especially digestive system carcinomas. Further studies are required to verify the significance of PNI in clinical practice.

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Abbreviations

CIs:

Confidence intervals

CSS:

Cancer-specific survival

HR:

Hazard ratio

HRs:

Hazard ratios

OR:

Odds ratio

ORs:

Odds ratios

OS:

Overall survival

PNI:

Prognostic nutritional index

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (Grant Nos. 81101865 and 81272637) and Doctoral Fund of Ministry of Education of China (Grant No. 20110171120064).

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China

    Kaiyu Sun, Jianbo Xu, Guanghua Li & Yulong He

  2. Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China

    Shuling Chen

Authors
  1. Kaiyu Sun
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  2. Shuling Chen
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  3. Jianbo Xu
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  4. Guanghua Li
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  5. Yulong He
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Corresponding author

Correspondence to Yulong He.

Additional information

Kaiyu Sun and Shuling Chen have contributed equally to the work.

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Sun, K., Chen, S., Xu, J. et al. The prognostic significance of the prognostic nutritional index in cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 140, 1537–1549 (2014). https://doi.org/10.1007/s00432-014-1714-3

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  • DOI: https://doi.org/10.1007/s00432-014-1714-3

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