The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: A meta-analysis
Introduction
Gastric cancer (GC) is one of the most frequent causes of cancer death worldwide, with an estimated occurrence of 951,600 new cases and 723,100 deaths in 2012.1 Despite developments in early diagnosis, surgery, adjuvant chemotherapy, and targeted therapies, the long-term survival is still unsatisfactory,2 perhaps owing to local recurrence and distant metastasis. Curative resection is still the most effective treatment for GC. On the other hand, some studies reported that postoperative complications, such as anastomotic leakage, can lead to poor prognosis in patients with GC.3, 4 It is valuable to identify patients who are likely to have unfavorable postoperative outcomes. Therefore, a method for the accurate prediction of postoperative complications and prognosis is needed to guide clinical decisions and improve the survival of patients.
The immune and nutritional status of patients was reported to be associated with the postoperative outcomes in malignant tumors.5, 6 The prognostic nutritional index (PNI), which was first designed by Buzby et al.,7 was calculated based on the serum albumin concentration and lymphocyte count in the peripheral blood.8 Recently, emerging evidence has demonstrated the prognostic value of PNI in different types of malignant tumors, including hepatocellular carcinoma,9 nasopharyngeal carcinoma,10 and colorectal cancer.11 Moreover, Sun et al.12 have performed a pooled analysis to estimate the prognostic value of PNI in cancer. However, owing to limited number of studies and their small sample sizes, the clinical value of PNI in GC has not reached a consensus. Therefore, whether the PNI can be a supplementary index together with the current TNM staging system to predict prognosis remain unknown. For this reason, a quantitative pooled study on PNI needs to be performed.
The aim of this study was to perform a meta-analysis to assess the prognostic value of PNI and the correlation between PNI and clinicopathological features in patients with GC.
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Literature search strategy
A comprehensive literature search was performed using the PubMed, Embase, and Web of Science databases up to November 30, 2015. The main search terms were “prognostic nutritional index” and “gastric cancer/stomach cancer/gastrointestinal cancer.” In addition, potentially relevant searches were performed by screening the references of the relevant articles.
Inclusion and exclusion criteria
The eligible studies were selected on the basis of the following criteria: (1) diagnosis of GC was based on pathological examination; (2)
Search results and study characteristics
A total of 639 potentially relevant studies were initially identified via database searches. After the initial review, 596 articles were excluded. Then, 33 studies were excluded after a full text review. Finally, 10 cohort studies involving 3396 patients were included in this meta-analysis18, 19, 20, 21, 22, 23, 24, 25, 26, 27 (Fig. 1).
These 10 studies were published between 2010 and 2015, and investigated the prognosis or clinicopathological features of GC, and their sample sizes ranged
Discussion
The prognostic and clinicopathological value of PNI has recently been studied in patients with many malignancies. However, the prognostic and clinicopathological role of PNI in GC patients is still not unclear. To the best of our knowledge, this is the first meta-analysis to systematically explore the prognostic role of PNI and the relationship between PNI and clinicopathological characteristics in patients with GC.
Our results indicated that a low preoperative PNI was a poor prognostic factor
Conclusions
PNI was significantly associated with patients survival, postoperative complications, and clinicopathological features in GC. However, a low PNI was not a significant predictor of poor OS in patients with stage IV GC.
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgments
This work was supported by Natural Science Foundation of Liaoning Province (No. 2014029201), Program of Education Department of Liaoning Province (L2014307) and the Key Laboratory Programme of Education Department of Liaoning Province (LZ2015076).
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Yuchong Yang and Peng Gao contributed equally to this work.