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

Abstract

Background

Numerous studies have explored whether the prognostic nutritional index (PNI) can predict the prognosis of cervical cancer (CC); however, their findings remain controversial. This meta-analysis focused on evaluating the relationship between the PNI and the prognosis of patients with CC.

Methods

Relevant articles were collected from specific databases up to March 16, 2023. The relationship between the PNI and survival outcomes in patients with CC was estimated using combined hazard ratios (HRs) and associated 95% confidence intervals (CIs). The association of the PNI with clinicopathological features in patients with CC was assessed by combining odds ratios (ORs) and associated 95% CIs.

Results

Nine articles with 2508 cases were included in the meta-analysis. According to our pooled findings, a decreased PNI showed a significant association with worse overall survival (OS) (HR = 2.98, 95% CI = 2.22–3.99, p < .001) as well as progression-free survival (PFS) (HR = 2.43, 95% CI = 1.92–3.07, p < .001) in patients with CC. The subgroup analysis indicated that the results were reliable. Moreover, the decreased PNI showed a significant association with the presence of lymph node metastasis (LN metastasis, OR = 1.53, 95% CI = 1.04–82.24, p = .030) and maximum tumor size >4 cm (OR = 1.73, 95% CI = 1.21–2.46, p = .002). However, the PNI was not significantly associated with histology, differentiation, or FIGO stage.

Conclusion

In this study, a low PNI predicted dismal OS and PFS in patients with CC, who also tend to suffer from LN metastasis and larger tumor size. PNI is a promising biomarker for predicting the prognosis of patients with CC in clinical practice.

KEY MESSAGES

1. To our knowledge, the present meta-analysis is the first to explore whether the PNI can be used to predict the prognosis of patients with CC.

2. In this study, a low PNI predicted dismal OS and PFS in patients with CC, who also tend to suffer from LN metastasis and larger tumor size.

3. PNI is a promising biomarker for predicting the prognosis of patients with CC in clinical practice.

Keywords:

• Cervical cancer
• meta-analysis
• prognostic nutritional index
• prognosis
• clinical practice

Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Authors contributions

ZN contributed the central idea, analyzed most of the data and wrote the main manuscript text. ZN and BY contributed to refining the ideas, collecting the data, carrying out additional analyses and revising the manuscript. All authors contributed to the article and approved the submitted version.

Ethics statement

Ethical approval was not required for this meta-analysis because all the data used in this study were obtained from published articles.

Disclosure statement

The authors declare that there is no conflict of interest.

Data availability statement

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

Additional information

Funding

This work was supported by grants from the National Natural Science Foundation of China (82172361, 82372329), Zhejiang Province Key Research and Development Project (2023C03048), and Medicine and Health Project of Zhejiang Province (2018KY276).