Jiang Ai-Min, Zhao Rui, Liu Na, Ma Yu-Yan, Ren Meng-Di, Tian Tao, Yao Yu
Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Thorac Dis. 2020 Oct;12(10):5718-5728. doi: 10.21037/jtd-20-1739.
Numerous studies identified that pretreatment prognostic nutritional index (PNI) was significantly associated with the prognosis in various kinds of malignant tumors. However, the prognostic value of PNI in small cell lung cancer (SCLC) remains controversial. We performed the present meta-analysis to estimate the prognostic value of PNI in SCLC and to explore the relationship between PNI and clinical characteristics.
We systematically and comprehensively searched PubMed, EMBASE, and Web of Science for available studies until April 17, 2020. Pooled hazard ratios (HRs) and their 95% confidence intervals (CIs) were used to evaluate the correlation between PNI and overall survival (OS) and progression-free survival (PFS) in SCLC. Odds ratios (ORs) and 95% CIs were applied to evaluate the relationship between clinical features and PNI in SCLC.
A total of nine studies with 4,164 SCLC patients were included in the meta-analysis. The pooled data elucidated that lower PNI status was an independent risk factor for worse OS in SCLC (HR =1.43; 95% CI: 1.24-1.64; P<0.001), while there was no significant correlation between PNI status and PFS (HR =1.44; 95% CI: 0.89-2.31; P=0.134). We also found that Eastern Cooperative Oncology Group (ECOG) performance status ≥2 (OR =2.72; 95% CI: 1.63-4.53; P<0.001) and extensive-stage (ES) disease (OR =1.93; 95% CI: 1.62-2.30; P<0.001) were risk factors for low PNI, while prophylactic cranial irradiation (PCI) (OR =0.53; 95% CI: 0.40-0.69; P<0.001) was a protective factor for low PNI.
Our findings suggested that low PNI status was closely correlated with the decreased OS in SCLC. Surveillance on PNI, amelioration of nutritional and immune status, and timely initiation of PCI may improve the prognosis of SCLC.
大量研究表明，治疗前预后营养指数（PNI）与各类恶性肿瘤的预后显著相关。然而，PNI在小细胞肺癌（SCLC）中的预后价值仍存在争议。我们进行了本次荟萃分析，以评估PNI在SCLC中的预后价值，并探讨PNI与临床特征之间的关系。
我们系统全面地检索了PubMed、EMBASE和Web of Science数据库，以获取截至2020年4月17日的可用研究。采用合并风险比（HR）及其95%置信区间（CI）来评估PNI与SCLC总生存期（OS）和无进展生存期（PFS）之间的相关性。采用比值比（OR）及其95%CI来评估SCLC临床特征与PNI之间的关系。
本次荟萃分析共纳入9项研究，涉及4164例SCLC患者。汇总数据表明，较低的PNI状态是SCLC患者OS较差的独立危险因素（HR =1.43；95%CI：1.24 - 1.64；P<0.001），而PNI状态与PFS之间无显著相关性（HR =1.44；95%CI：0.89 - 2.31；P =0.134）。我们还发现，东部肿瘤协作组（ECOG）体能状态≥2（OR =2.72；95%CI：1.63 - 4.53；P<0.001）和广泛期（ES）疾病（OR =1.93；95%CI：1.62 - 2.30；P<0.001）是低PNI的危险因素，而预防性颅脑照射（PCI）（OR =0.53；95%CI：0.40 - 0.69；P<0.001）是低PNI的保护因素。
我们的研究结果表明，低PNI状态与SCLC患者OS降低密切相关。监测PNI、改善营养和免疫状态以及及时进行PCI可能会改善SCLC的预后。
