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

Sun, Ke; Chen, Shu‐Ling; Xu, Jianbo; Li, Guanghua; He, Yulong

doi:10.1007/s00432-014-1714-3

Cited by 303 publications

(244 citation statements)

References 26 publications

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“…This implies that the predictive significance of PNI might be greater in advanced gastric cancer, which is supported by the finding that PNI was only significantly associated with OS in patients with deeper tumor invasion and lymph node metastasis. This result is consistent with that of our meta-analysis and the findings of other studies [4,28] . This dependence on tumor invasion and spread might reflect the relatively good immunological and nutritional status of gastric cancer patients with stage Ⅰ disease, and that gastric cancer was not always considered to be the major cause of death in these patients.…”

Section: Discussionsupporting

confidence: 94%

Novel immunological and nutritional-based prognostic index for gastric cancer

Sun

Chen

et al. 2015

WJG

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AIM:To assess the prognostic significance of immunological and nutritional-based indices, including the prognostic nutritional index (PNI), neutrophillymphocyte ratio (NLR), and platelet-lymphocyte ratio in gastric cancer. METHODS:We retrospectively reviewed 632 gastric cancer patients who underwent gastrectomy between 1998 and 2008. Areas under the receiver operating characteristic curve were calculated to compare the predictive ability of the indices, together with estimating the sensitivity, specificity and agreement rate. Univariate and multivariate analyses were performed to identify risk factors for overall survival (OS). Propensity score analysis was performed to adjust variables to control for selection bias. RESULTS:Each index could predict OS in gastric cancer patients in univariate analysis, but only PNI had independent prognostic significance in multivariate analysis before and after adjustment with propensity scoring (hazard ratio, 1.668; 95% confidence interval: 1.368-2.035). In subgroup analysis, a low PNI predicted a significantly shorter OS in patients with stage Ⅱ- Retrospective Study ORIGINAL ARTICLEⅢ disease (P = 0.019, P < 0.001), T3-T4 tumors (P < 0.001), or lymph node metastasis (P < 0.001). Canton score, a combination of PNI, NLR, and platelet, was a better indicator for OS than PNI, with the largest area under the curve for 12-, 36-, 60-mo OS and overall OS (P = 0.022, P = 0.030, P < 0.001, and P = 0.024, respectively). The maximum sensitivity, specificity, and agreement rate of Canton score for predicting prognosis were 84.6%, 34.9%, and 70.1%, respectively. CONCLUSION:PNI is an independent prognostic factor for OS in gastric cancer. Canton score can be a novel preoperative prognostic index in gastric cancer. Core tip: This is the first study to compare the prognostic significance of different immuno-nutritional indices including prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR) and plateletlymphocyte ratio (PLR) in gastric cancer. We found that PNI was an independent prognostic factor for overall survival in gastric cancer before and after the propensity score analysis, especially in patients with advanced disease, deep tumors, or lymph node metastasis. We also proposed that a new index-Canton score (a combination of PNI, NLR and PLT) is a superior prognostic factor compared to PNI, NLR, or PLR alone, as it better represents the relative contribution of each of these indices.Sun KY, Xu JB, Chen SL, Yuan YJ, Wu H, Peng JJ, Chen CQ, Guo P, Hao YT, He YL. Novel immunological and nutritionalbased prognostic index for gastric cancer.

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Section: Discussionsupporting

confidence: 94%

Novel immunological and nutritional-based prognostic index for gastric cancer

Sun

Chen

et al. 2015

WJG

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“…It is well known that preoperative physical status, comorbidities, and biomarkers of metabolic and physiological status, such as albumin, are associated with surgical morbidity and mortality risk [22][23][24]. Metabolic status evaluated by laboratory data such as the prognostic nutritional index and patients' frailty, assessed by sarcopenia, have been associated with surgical complications risk and the prognosis in patients with cancers [25][26][27]. Furthermore, it should be noted that prognosis in patients with cancer depends not only on tumor-specific pathological factors but also on host-related factors, in particular, systemic inflammatory response [28].…”

Section: Discussionmentioning

confidence: 99%

The Controlling Nutritional Status Score and Postoperative Complication Risk in Gastrointestinal and Hepatopancreatobiliary Surgical Oncology: A Systematic Review and Meta-Analysis

Takagi¹,

Domagała²,

Polak

et al. 2019

Ann Nutr Metab

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The controlling nutritional status (CONUT) score is associated with prognosis in gastrointestinal (GI) cancer patients, but the clinical significance of the CONUT score for postoperative short-term outcome remains controversial. The aim of this study was to investigate the impact of the CONUT score on postoperative outcomes in patients with GI and hepatopancreatobiliary (HPB) cancers. We conducted a systematic literature search of Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. Meta-analyses were performed to estimate the pooled risk ratio (RR) for postoperative complications in patients with lower CONUT score versus higher CONUT score. Furthermore, we explored the most appropriate cutoff value of the CONUT score to predict postoperative complications. Ten retrospective studies (5,138 patients) were included in this meta-analysis. Patients with higher CONUT score had an increased risk of mortality (RR 5.38, 95% CI 2.19–13.2, p < 0.001, I² = 0%), postoperative major complications (RR 1.56, 95% CI 1.05–2.33, p= 0.03, I² = 79%), and overall complications (RR 1.38, 95% CI 1.16–1.63, p < 0.001, I² = 6%). We found that the cutoff of CONUT ≤4 vs. CONUT ≥5 had the highest pooled RR compared with other cutoff values (RR 4.79, 95% CI 0.97–23.5, p= 0.05, I² = 91%). In conclusion, the present study suggests that the preoperative CONUT score was associated with an increased risk of mortality and complications in GI and HPB surgical oncology. Patients with higher CONUT score as compared with those having a lower score had approximately a fivefold mortality risk and an increased risk up to 55% on major and overall complications after GI and HPB surgery. Our analysis indicates that the appropriate cutoff value of the CONUT score to predict postoperative major complications would be between 4 and 5. The preoperative evaluation of the CONUT score would be helpful for predicting the risk of postoperative outcomes.

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“…The PNI was calculated as the following formula: 10 × albumin levels (g/dL) + 0.005 × total lymphocyte count (/mm 3 ). Patients were divided into 2 groups based on PNI: the low PNI group (score < 40) and high PNI group (score ≥40) [3,4].…”

Section: Clinical Datamentioning

confidence: 99%

“…Preoperative nutritional status, as assessed by the prognostic nutritional index (PNI), has been widely used especially in predicting short-and long-term outcomes in patients with different types of cancer [3]. The significance of the PNI in predicting postoperative outcomes has been reported in patients with hepatocellular carcinoma (HCC) after hepatectomy [4].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Controlling Nutritional Status Score Predicts Mortality after Hepatectomy for Hepatocellular Carcinoma

et al. 2018

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Background: Preoperative nutritional status is reportedly associated with postoperative outcomes in patients with hepatocellular carcinoma. This study aimed to investigate the significance of the controlling nutritional status (CONUT) score and the prognostic nutritional index (PNI) as predictors of postoperative outcomes. Methods: We retrospectively reviewed data from 331 patients who underwent hepatectomy for hepatocellular carcinoma between January 2007 and December 2015. Patients were divided into 2 groups based on their CONUT score and the PNI. We evaluated the effect of the CONUT score and PNI on perioperative outcomes. Multivariate analysis was performed to identify independent predictors of in-hospital mortality after hepatectomy. Results: The high CONUT group had a significantly higher incidence of 30-day mortality (p < 0.001), in-hospital mortality (p = 0.002), ascites (p = 0.006), liver failure (p = 0.02), sepsis (p = 0.01), and enteritis (p < 0.001). The low PNI group was also significantly associated with 30-day mortality (p < 0.001), in-hospital mortality (p = 0.003), liver failure (p < 0.001), sepsis (p = 0.02), enteritis (p = 0.02), and hospital stay (p = 0.01). In multivariate analyses, a high CONUT score was an independent predictor of in-hospital mortality after hepatectomy (hazard ratio [HR] 9.41, p = 0.038), but the PNI was not (HR 5.86, p = 0.08). Conclusions: Preoperative assessment of the CONUT score is helpful for evaluating patients’ nutritional status and mortality risk after liver surgery.

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

Abstract: 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.

Cited by 303 publications

References 26 publications

Novel immunological and nutritional-based prognostic index for gastric cancer

Novel immunological and nutritional-based prognostic index for gastric cancer

The Controlling Nutritional Status Score and Postoperative Complication Risk in Gastrointestinal and Hepatopancreatobiliary Surgical Oncology: A Systematic Review and Meta-Analysis

Preoperative Controlling Nutritional Status Score Predicts Mortality after Hepatectomy for Hepatocellular Carcinoma

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