Prognostic and clinicopathological effect of the prognostic nutritional index (PNI) in patients with cervical cancer: a meta-analysis

Figures & data

Figure 1. PRISMA Flow chart of the data search.

Table 1. Basic characteristics of included studies in this meta-analysis.

Study	Year	Country	Sample size	Age (years) Median(range)	Study duration	FIGO stage	Treatment	Follow-up (months) Median(range)	Cut-off value	Cut-off determination	Survival endpoint	Survival analysis	NOS score
Haraga, J.	2016	Japan	131	61.5(25–88)	2007–2013	I–IV	CCRT	60	48.55	ROC curve	OS, PFS	Multivariate	7
He, X.	2018	China	229	44(28–79)	2007–2009	I–IV	Surgery+ CCRT	83	45	Literature	OS	Univariate	7
Zhang, W.	2018	China	235	46(29–78)	2005–2009	I–II	Mixed	77(32–96)	50.38	ROC curve	OS, PFS	Univariate	8
Ren, J. L.	2020	China	324	51.6(25–84)	2015–2016	I–IV	CCRT	39(4–59)	49.55	ROC curve	OS, PFS	Multivariate	7
Jiang, Y. A.	2021	China	583	≤45 y: 203 >45 y: 380	2009–2017	I–II	Surgery	68	50.15	ROC curve	OS, PFS	Univariate	9
Zhang, G.	2021	China	698	51	2004–2015	I–II	Surgery+ CCRT	56.2(4.9–186.9)	48.55	Literature	OS, PFS	Multivariate	8
Zhang, Z. C.	2022	China	82	50.13(40–60)	2015–2017	I–III	Surgery+ CCRT	1–36	48.82	ROC curve	OS	Univariate	6
Zhu, J. M.	2022	China	117	<60 y: 70 ≥60 y: 47	2019–2021	I–IV	Surgery+ CCRT	1–12	46.2	ROC curve	PFS	Univariate	7
Guo, J.	2023	China	109	53.95(27–71)	2014–2017	I–II	Surgery	1–96	52.68	ROC curve	OS	Univariate	7

FIGO: International Federation of Gynecology and Obstetrics; CCRT: concurrent chemoradiotherapy; ROC: receiver operating characteristics; OS: overall survival; PFS: progression-free survival; NOS: Newcastle-Ottawa Scale.

Figure 2. Forest plots of prognostic role of PNI for OS in patients with cervical cancer.

Table 2. Subgroup analysis of prognostic role of PNI for OS in patients with cervical cancer.

	No. of	No. of				Heterogeneity
Subgroup	studies	patients	HR (95%CI)	p	Effects model	I^2(%)	Ph
Total	8	2391	2.98(2.22–3.99)	<.001	Fixed	6.1	0.383
Country
China	7	2260	2.93(2.14–4.02)	<.001	Fixed	18.8	0.286
Japan	1	131	3.27(1.48–7.24)	.003	–	–	–
Sample size
≤230	4	551	3.33(1.93–5.75)	<.001	Fixed	0	0.869
>230	4	1840	2.81(1.65–4.79)	<.001	Random	53.9	0.089
FIGO stage
I–II	4	1625	2.39(1.56–3.67)	<.001	Fixed	37.4	0.188
I–III	1	82	3.21(1.02–10.07)	.046	–	–	–
I–IV	3	684	3.68(2.39–5.67)	<.001	Fixed	0	0.699
Cut-off value
≤49	4	1140	2.16(1.39–3.35)	.001	Fixed	4.4	0.371
>49	4	1251	3.87(2.61–5.75)	<.001	Fixed	0	0.907
Cut-off determination
ROC curve	6	1464	3.69(2.63–5.18)	<.001	Fixed	0	0.980
Literature	2	927	1.54(0.85–2.78)	.152	Fixed	0	0.541
Survival analysis
Multivariate	3	1153	2.70(1.37–5.34)	.004	Random	68.8	0.041
Univariate	5	1238	3.33(2.06–5.37)	<.001	Fixed	0	0.949
Treatment
Surgery + CCRT	3	1009	1.80(1.06–3.04)	.029	Fixed	0	0.446
CCRT	2	455	3.86(2.46–6.07)	<.001	Fixed	0	0.618
Surgery	2	692	3.72(1.88–7.33)	<.001	Fixed	0	0.555
Mixed	1	235	3.24(1.16–9.06)	.025	–	–	–

FIGO: International Federation of Gynecology and Obstetrics; ROC: receiver operating characteristics; OS: overall survival.

Figure 3. Forest plots of prognostic role of PNI for PFS in patients with cervical cancer.

Table 3. Subgroup analysis of prognostic role of PNI for PFS in patients with cervical cancer.

	No. of	No. of				Heterogeneity
Subgroup	studies	patients	HR (95%CI)	p	Effects model	I^2(%)	Ph
Total	6	2088	2.43(1.92–3.07)	<.001	Fixed	35.4	0.171
Country
China	5	1957	2.43(1.90–3.12)	<.001	Fixed	48.3	0.102
Japan	1	131	2.38(1.21–4.67)	.012	–	–	–
Sample size
≤230	2	248	2.97(1.69–5.23)	<.001	Fixed	27.6	0.240
>230	4	1,840	2.33(1.80–3.01)	<.001	Fixed	48.0	0.123
FIGO stage
I–II	3	1516	1.85(1.32–2.58)	<.001	Fixed	0	0.510
I–IV	3	572	3.14(2.27–4.36)	<.001	Fixed	0	0.486
Cut-off value
≤49	3	946	2.31(1.31–4.06)	.004	Random	52.3	0.123
>49	3	1142	2.84(2.06–3.90)	<.001	Fixed	0	0.460
Cut-off determination
ROC curve	5	1390	2.87(2.17–3.79)	<.001	Fixed	0	0.566
Literature	1	698	1.61(1.04–2.49)	.032	–	–	–
Survival analysis
Multivariate	3	1153	2.32(1.46–3.68)	<.001	Random	62.5	0.069
Univariate	3	935	2.66(1.66–4.26)	<.001	Fixed	9.5	0.331
Treatment
Surgery + CCRT	2	815	2.56(0.86–7.64)	.091	Random	74.3	0.049
CCRT	2	455	2.99(2.12–4.22)	<.001	Fixed	0	0.443
Surgery	1	583	2.00(1.05–3.81)	.035	–	–	–
Mixed	1	235	2.90(1.15–7.32)	.024	–	–	–

FIGO: International Federation of Gynecology and Obstetrics; ROC: receiver operating characteristics; PFS: progression-free survival.

Figure 4. Forest plots of association between PNI and clinicopathological factors in patients with cervical cancer. (A) histology; (B) lymph node metastasis; (C) differentiation; (D) maximum tumor size; (E) FIGO stage (II vs I); and (F) FIGO stage (III–IV vs I–II).

Table 4. The correlation between PNI and clinicopathological features in patients with cervical cancer.

	No. of	No. of				Heterogeneity
Variables	studies	patients	OR (95%CI)	p	Effects model	I^2(%)	Ph
Histology (non-SCC vs SCC)	3	989	1.41(0.66–2.98)	.374	Random	52.7	0.120
LN metastasis (yes vs no)	3	515	1.53(1.04–82.24)	.030	Fixed	0	0.382
Differentiation (poor vs well/moderate)	2	665	0.76(0.51–1.12)	.168	Fixed	0	0.982
Maximum tumor size (cm) (>4 vs ≤4)	2	907	1.73(1.21–2.46)	.002	Fixed	0	0.648
FIGO stage (II vs I)	2	692	0.90(0.61–1.35)	.624	Fixed	0	0.478
FIGO stage (III–IV vs I–II)	2	406	1.97(0.70–5.56)	.199	Random	73.7	0.051

SCC: squamous cell carcinoma; LN: lymph node.

Figure 5. Publication bias test by using Begg’s test and Egger’s test. (A) Begg’s test for OS, p = .536; (B) Egger’s test for OS, p = .819; (C) Begg’s test for PFS, p = .452; (D) Egger’s test for PFS, p = .573.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.