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  • Clinical Research
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Prognostic value of a baseline prognostic nutritional index for patients with prostate cancer: a systematic review and meta-analysis

Prostate Cancer and Prostatic Diseases (2023)Cite this article

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Abstract

Background

The prognostic nutritional index (PNI) integrates both nutritional and immune indicators and provides promising prognostic value for various malignancies. However, there is still no specific consensus relating to the precise relationship between the pretreatment PNI and the survival outcome of patients with prostate cancer (PCa). Here, we performed a meta-analysis to determine the prognostic significance of PNI for patients with PCa.

Methods

We used the PubMed, EMBASE, Web of Science, Cochrane Library (CENTRAL), and CNKI databases to identify and retrieve eligible articles that were published in any language up to the 1st March 2023. Our analysis considered hazard ratios (HRs) and 95% confidence intervals (CIs) published in the included studies. Data synthesis and analysis were conducted using Stata 15.1 software.

Results

A total of ten studies featuring 1631 cases were included in our quantitative analysis. Analysis showed that a low PNI at baseline was significantly associated with poor overall survival (OS) (HR: 2.16; 95% CI: 1.40–3.34; p = 0.01), progression-free survival (PFS) (HR: 2.17; 95% CI 1.63–2.89; p < 0.001). Owing to high levels of heterogeneity, we performed subgroup analysis based on disease staging, sample size, and cutoff value; we found that disease staging may have been the source of the heterogeneity. A low pretreatment PNI was associated with poor survival outcomes for both metastatic castration-resistant prostate cancer (mCRPC) patients and nonmetastatic castration-resistant prostate cancer (nmCRPC) patients.

Conclusions

A low pretreatment PNI was significantly correlated with a worse OS and PFS in patients with PCa. A low pretreatment PNI may act as a reliable and effective predictor for the prognosis of patients with PCa. Further well-designed studies should be performed to fully evaluate the prognostic performance of this novel indicator for PCa.

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Fig. 1
Fig. 2: Forest plot showing the association between prognostic nutritional index (PNI) and overall survival (OS) or progression-free survival (PFS).
Fig. 3: Relationship between categorized PNI and prognosis in patients with mCRPC and nmCRPC.
Fig. 4: Funnel plot for overall survival (OS) and progression-free survival (PFS).
Fig. 5: Sensitivity analysis using the leave-one-out method for overall survival (OS) and progression-free survival (PFS).

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Funding

Funding

This study was supported by the Key Research and Development Projects of Sichuan Science and Technology Department (References: 23ZDYF2070, 2022YFS0135) and the Popular Application Reference: SCR2023-210).

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Author notes

  1. These authors contributed equally: Yang Zheng, Kai Wang, Yong Ou.

Authors and Affiliations

  1. School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610054, China

    Yang Zheng, Yong Ou & Ziyan Wang

  2. Robotic Minimally Invasive Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, 610072, Sichuan, China

    Yang Zheng, Yong Ou, Dong Wang & Shangqing Ren

  3. Department of Acute Care Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, 610072, Sichuan, China

    Kai Wang

  4. Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Xu Hu

  5. The Sichuan Provincial Key Laboratory for Human Disease Gene Study and Department of Laboratory Medicine, Center for Medical Genetics, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan, China

    Ziyan Wang

  6. Laboratory of Ageing Research, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China

    Ziyan Wang

  7. Department of Pathology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, 610072, Sichuan, China

    Xinglan Li

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Contributions

YZ, KW and SR: study conception and design, acquisition of data, analysis and interpretation of data and manuscript drafting. YO, YZ and ZW: acquisition of data, analysis, and interpretation of data. XH: acquisition of data, manuscript drafting and critical revision. YZ and SR: study conception and design, manuscript drafting and critical revision. DW, XL and YZ: study conception and design, manuscript drafting and critical revision. YZ and SR: study conception and design, acquisition of data, manuscript drafting and critical revision.

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Correspondence to Dong Wang, Xinglan Li or Shangqing Ren.

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Zheng, Y., Wang, K., Ou, Y. et al. Prognostic value of a baseline prognostic nutritional index for patients with prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00689-9

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