The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: A meta-analysis

Background: The clinical value of the prognostic nutritional index (PNI) in gastric cancer (GC) remains controversial. Therefore, we performed the meta-analysis to determine the prognostic and clinicopathological values of PNI in patients with GC.

Methods: A literature search was performed in the PubMed, Embase, and Web of Science databases. Hazard ratios (HRs) and odds ratios (ORs) were extracted to estimate the association of PNI with survival and clinicopathological characteristics, respectively.

Results: Ten studies involving 3396 patients with GC were analyzed. The pooled results indicated that a low PNI was a significant predictor of poor overall survival (OS) (HR = 1.89, 95% confidence interval [CI] = 1.67-2.13, P < 0.01) and postoperative complications (OR = 1.74, 95% CI = 1.41-2.16, P < 0.01). In the subgroup analysis, a low PNI was significantly associated with poor OS in patients with GC at stage I, II and III, but not at stage IV (HR = 1.14, 95% CI = 0.84-1.55, P = 0.40). Moreover, a low PNI was significantly associated with more advanced tumor features, such as older age, deeper depth of tumor, positive lymph node metastasis, more advanced TNM stages, and positive vessel and lymphatic invasion.

Conclusion: PNI was a predictive indicator of survival and postoperative complications, and was associated with clinicopathological features in GC patients. However, a low PNI was not significantly associated with poor OS in patients with GC at stage IV.