Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Department of Hepatobiliary and Gastrointestinal Surgery, Affiliated Nationalities Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Medicine (Baltimore). 2024 Oct 11;103(41):e39917. doi: 10.1097/MD.0000000000039917.
The value of prognostic nutritional index (PNI) in gastrectomy remains controversial. This meta-analysis aimed to evaluate the predictive value of PNI in patients undergoing gastrectomy for malignancy.
We retrieved studies from medical literature databases to analyze the endpoints of overall survival, cancer-specific survival, recurrence-free survival, and clinicopathologic features. The hazard ratio (HR) and 95% confidence interval (CI) were used to access the survival prognostic value of PNI in patients after gastrectomy. Odds ratio and mean difference were used to evaluate the relationship between the low PNI and clinicopathologic features.
In total, we included 38 articles (39 trial comparisons) which contained 23,756 gastrectomy patients. The results showed that low PNI was associated with shorter overall survival (HR: 1.82, 95% CI 1.62-2.03), shorter cancer-specific survival (HR: 1.44, 95% CI 1.24-1.67), and shorter recurrence-free survival (HR: 2.52, 95% CI 1.41-4.47). Besides, patients with low PNI had a higher risk of postoperative complications compared with high PNI (HR: 1.65, 95% CI 1.30-2.09). And low PNI group was found to be related to older, lower BMI, larger tumor size, deeper tumor invasion, poorer differentiation, more advanced tumor stage, total gastrectomy, and the presence of lymph node metastasis, lymphatic invasion, and vessel invasion.
PNI was significantly associated with survival and postoperative complications of gastric cancer patients undergoing gastrectomy. Therefore PNI has the potential to be a prognostic predictor for gastrectomy.
预后营养指数（PNI）在胃癌手术中的价值仍存在争议。本荟萃分析旨在评估 PNI 对接受恶性肿瘤胃切除术患者的预测价值。
我们从医学文献数据库中检索研究，分析总生存率、癌症特异性生存率、无复发生存率和临床病理特征等终点。使用风险比（HR）和 95%置信区间（CI）评估 PNI 对胃切除术后患者生存预后的价值。使用比值比和均数差评估低 PNI 与临床病理特征之间的关系。
共纳入 38 篇文章（39 项试验比较），包含 23756 例胃切除术患者。结果表明，低 PNI 与总生存率缩短相关（HR：1.82，95%CI 1.62-2.03）、癌症特异性生存率缩短（HR：1.44，95%CI 1.24-1.67）和无复发生存率缩短（HR：2.52，95%CI 1.41-4.47）。此外，与高 PNI 相比，低 PNI 患者术后并发症风险更高（HR：1.65，95%CI 1.30-2.09）。并且，低 PNI 组与年龄较大、BMI 较低、肿瘤较大、侵袭深度较深、分化较差、肿瘤分期较晚、全胃切除术以及存在淋巴结转移、淋巴管浸润和血管浸润有关。
PNI 与接受胃切除术的胃癌患者的生存和术后并发症显著相关。因此，PNI 有可能成为胃切除术的预后预测指标。
