Prognostic Nutritional Index (PNI) as Independent Predictor of Poor Survival in Prostate Cancer: A Systematic Review and Meta-Analysis

Evidence regarding the utility of prognostic nutritional index (PNI) in prostate cancer is still conflicting. We conducted a meta-analysis with a total of 2229 prostate cancer patients from 13 studies. Our meta-analysis showed that low PNI score was associated with worse overall survival (OS) and progression-free survival (PFS) in prostate cancer, therefore can be used as risk stratification tool. Background: The concentration of albumin and lymphocyte in the body can serve as indicators of both nutritional status and inflammation. The predictive significance of the prognostic nutritional index (PNI) has been documented in multiple cancer types. Consequently, a meta-analysis was conducted in order to investigate the prognostic impact of PNI on survival outcomes among individuals diagnosed with prostate cancer. Methods: A systematic search was conducted across 4 electronic databases to identify pertinent studies that evaluated the predictive significance of pretreatment PNI in patients with prostate cancer. The outcomes of interest in this study were overall survival (OS) and progression-free survival (PFS). The researchers utilized random-effect models to summarize the time-to-event outcomes, presenting the results as adjusted hazard ratios (aHR) along with their corresponding 95% confidence intervals (CI). Results: A total of 2229 prostate cancer patients in 13 studies were included. Pooled analysis from these studies showed that low PNI value was associated with shorter OS [aHR 1.99 (95% CI, 1.45-2.72), P < .0001], and PFS [aHR 1.97 (95% CI, 1.55-2.51), P < .00001]. Sub-group analysis revealed that the ability of PNI to predict poor outcomes was better observed in patients with metastatic castration-resistant prostate cancer (mCRPC) and those who received androgen receptor pathway inhibitors (ARPIs). Conclusions: This study suggests the role of PNI in predicting the survival and progression of prostate cancer. PNI values can be used in the risk stratification of patients with prostate cancer.