根治性肝切除术后肝细胞癌患者术前预后营养指数的预后意义：一项荟萃分析和系统评价
Prognostic significance of preoperative prognostic nutritional index in hepatocellular carcinoma after curative hepatectomy: a meta-analysis and systemic review.
作者信息
Zhang Haiyan, Li Dan, Li Jing
机构信息
Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Front Nutr. 2024 Dec 23;11:1433528. doi: 10.3389/fnut.2024.1433528. eCollection 2024.
BACKGROUND
The Prognostic Nutritional Index (PNI), which reflects both nutritional and immune status, has emerged as a potential predictor of survival outcomes in cancer patients. However, its role in forecasting the prognosis of hepatocellular carcinoma (HCC) following curative hepatectomy remains unclear. To further investigate the association between PNI and survival outcomes in HCC patients, we conducted a systematic review and meta-analysis.
METHODS
We performed a comprehensive search across Web of Science, PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure to identify studies evaluating the prognostic value of PNI in HCC following curative hepatectomy. Overall survival (OS), recurrence-free survival (RFS), and disease-free survival (DFS) were extracted as primary outcomes. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effect models. Additionally, heterogeneity, publication bias, and sensitivity analyses were performed to evaluate the consistency and robustness of the obtained results.
RESULTS
This systematic review and meta-analysis included 19 studies comprising a total of 9,830 patients. The results indicated that higher PNI was significantly associated with longer overall survival (OS) ( = 6,812; HR = 1.60; 95% CI: 1.44-1.77; < 0.001) and recurrence-free survival (RFS) ( = 8,529; HR = 1.48; 95% CI: 1.30-1.69; < 0.001). There was significant heterogeneity among studies for RFS ( = 56.0%, = 0.004). Subgroup analysis indicated that age, variations in PNI cutoff values and follow-up periods were the primary contributors to this heterogeneity. The trim-and-fill method indicated that publication bias did not impact the OS results, and Egger's test found no publication bias for RFS ( = 0.104). Sensitivity analysis further confirmed the stability of these results.
CONCLUSION
Preoperative PNI is a significant prognostic indicator in HCC patients undergoing curative hepatectomy, with higher PNI correlating with improved survival outcomes.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024530150, identifier CRD42024530150.
背景
预后营养指数（PNI）反映了营养和免疫状态，已成为癌症患者生存结局的潜在预测指标。然而，其在预测根治性肝切除术后肝细胞癌（HCC）预后中的作用仍不明确。为了进一步研究PNI与HCC患者生存结局之间的关联，我们进行了一项系统评价和荟萃分析。
方法
我们在Web of Science、PubMed、Embase、Cochrane图书馆和中国知网进行了全面检索，以识别评估PNI在根治性肝切除术后HCC中预后价值的研究。提取总生存期（OS）、无复发生存期（RFS）和无病生存期（DFS）作为主要结局。使用固定效应或随机效应模型计算合并风险比（HRs）及95%置信区间（CIs）。此外，进行了异质性、发表偏倚和敏感性分析，以评估所得结果的一致性和稳健性。
结果
该系统评价和荟萃分析纳入了19项研究，共9830例患者。结果表明，较高的PNI与更长的总生存期（OS）显著相关（n = 6812；HR = 1.60；95% CI：1.44 - 1.77；P < 0.001）和无复发生存期（RFS）（n = 8529；HR = 1.48；95% CI：1.30 - 1.69；P < 0.001）。RFS研究之间存在显著异质性（I² = 56.0%，P = 0.004）。亚组分析表明，年龄、PNI临界值变化和随访期是导致这种异质性的主要因素。剪补法表明发表偏倚不影响OS结果，Egger检验发现RFS无发表偏倚（P = 0.104）。敏感性分析进一步证实了这些结果的稳定性。
结论
术前PNI是接受根治性肝切除术的HCC患者的重要预后指标，较高的PNI与改善的生存结局相关。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024530150，标识符CRD42024530150。
Zotero 插件