Association of prognostic nutritional index with prognostic outcomes in patients with glioma: a meta-analysis and systematic review

Kuo-Chuan Hung; Cheuk-Kwan Sun; Yang-Pei Chang; Jheng-Yan Wu; Po-Yu Huang; Ting-Hui Liu; Chien-Hung Lin; Wan-Jung Cheng; I-Wen Chen

doi:10.3389/fonc.2023.1188292

Association of prognostic nutritional index with prognostic outcomes in patients with glioma: a meta-analysis and systematic review

Front Oncol. 2023 Jul 24:13:1188292. doi: 10.3389/fonc.2023.1188292. eCollection 2023.

Authors

Kuo-Chuan Hung^{1

2}, Cheuk-Kwan Sun^{3

4}, Yang-Pei Chang^{5

6}, Jheng-Yan Wu⁷, Po-Yu Huang⁸, Ting-Hui Liu⁹, Chien-Hung Lin², Wan-Jung Cheng¹⁰, I-Wen Chen¹⁰

Affiliations

¹ School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
² Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
³ Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan.
⁴ School of Medicine for International, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
⁵ Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁶ Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁷ Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan.
⁸ Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
⁹ Department of General Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
¹⁰ Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan.

Abstract

Background: The potential link between Prognostic Nutritional Index (PNI) and prognosis in patients with glioma remains uncertain. This meta-analysis was conducted to assess the clinical value of PNI in glioma patients by integrating all available evidence to enhance statistical power.

Method: A systematic search of databases including Medline, EMBASE, Google Scholar, and Cochrane Library was conducted from inception to January 8, 2023 to retrieve all pertinent peer-reviewed articles. The primary outcome of the study was to examine the association between a high PNI value and overall survival, while secondary outcome included the relationship between a high PNI and progression-free survival.

Results: In this meta-analysis, we included 13 retrospective studies published from 2016 to 2022, which analyzed a total of 2,712 patients. Across all studies, surgery was the primary treatment modality, with or without chemotherapy and radiotherapy as adjunct therapies. A high PNI was linked to improved overall survival (Hazard Ratio (HR) = 0.61, 95% CI: 0.52 to 0.72, p < 0.00001, I^{2 =}25%), and this finding remained consistent even after conducting sensitivity analysis. Subgroup analyses based on ethnicity (Asian vs. non-Asian), sample size (<200 vs. >200), and source of hazard ratio (univariate vs. multivariate) yielded consistent outcomes. Furthermore, patients with a high PNI had better progression-free survival than those with a low PNI (HR=0.71, 95% CI: 0.58 to 0.88, p=0.001, I^{2 =}0%).

Conclusion: Our meta-analysis suggested that a high PNI was associated with better overall survival and progression-free survival in patients with glioma. These findings may have important implications in the treatment of patients with glioma. Additional studies on a larger scale are necessary to investigate if integrating the index into the treatment protocol leads to improved clinical outcomes in individuals with glioma.

Systematic review registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42023389951].

Keywords: glioma; nutrition; overall survival; prognosis; prognostic nutritional index; progression-free survival.

Publication types

Systematic Review

Grants and funding

This research was funded by Chi Mei Medical Center, Tainan, Taiwan, grant number CMOR11203. The APC was funded by CMOR 11203.