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The prognostic role of prognostic nutritional index in nasopharyngeal carcinoma: A systematic review and meta-analysis

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Abstract

Purpose

The prognostic utility of the prognostic nutritional index (PNI) in nasopharyngeal carcinoma (NPC) has never been systematically reviewed. Therefore, we performed this meta-analysis.

Methods

We performed comprehensive research via Embase, PubMed, Web of Science and the Cochrane Library. The pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were applied to explore the relationship between PNI and overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS) and clinical features. Both univariate analysis (UVA) and multivariate analysis (MVA) were used.

Results

A total of 8 eligible studies including 3631 patients were ultimately enrolled. A low PNI level was significantly associated with a shorter OS [(HR 2.06, P < 0.00001; UVA) and (HR 1.78, P < 0.00001; MVA)], PFS [(HR 2.27, P = 0.006; UVA) and (HR 1.45, P = 0.0003; MVA)] and DMFS [(HR 2.06, P < 0.00001; UVA) and (HR 2.04, P < 0.00001; MVA)]. However, only one study reported the LRFFS of NPC patients, and there was no significant difference [HR 1.68, P = 0.26]. Furthermore, female patients, higher tumor stage, a lower alanine transaminase (ALT) level and a lower white blood cell (WBC) level were associated with a lower PNI level.

Conclusion

Our meta‐analysis indicated that NPC patients with a low PNI level had worse OS, PFS and DMFS, and a low PNI level was associated with female patients, higher tumor stage, a lower ALT level and a lower WBC level. These findings indicate that PNI is a promising prognostic biomarker.

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Authors and Affiliations

  1. Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yu Zhong District, Chongqing, 400016, People’s Republic of China

    Min Tang & Ju Zhang

  2. Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yu Zhong District, Chongqing, 400016, People’s Republic of China

    Zhongxiong Jia

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  1. Min Tang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by, Min Tang, Zhongxiong Jia and Ju Zhang. The first draft of the manuscript was written by Min Tang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ju Zhang.

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Supplementary file1 (TIF 60 kb)

Funnel plot of the hazard ratio of overall survival (OS) (UVA) (Beggʼs test, P = 0.221)

Supplementary file2 (TIF 60 kb)

Funnel plot of the hazard ratio of overall survival (OS) (MVA) (Beggʼs test, P = 0.060)

Supplementary file3 (TIF 62 kb)

Funnel plot of the hazard ratio of progression-free survival (PFS) (UVA) (Beggʼs test, P = 0.602)

Supplementary file4 (TIF 62 kb)

Funnel plot of the hazard ratio of progression-free survival (PFS) (MVA) (Beggʼs test, P = 0.734)

Supplementary file5 (TIF 59 kb)

Funnel plot of the hazard ratio of distant metastasis-free survival (DMFS) (UVA) (Beggʼs test, P = 1.000)

Supplementary file6 (TIF 59 kb)

Funnel plot of the hazard ratio of distant metastasis-free survival (DMFS) (MVA) (Beggʼs test, P =1.000)

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Tang, M., Jia, Z. & Zhang, J. The prognostic role of prognostic nutritional index in nasopharyngeal carcinoma: A systematic review and meta-analysis. Int J Clin Oncol 26, 66–77 (2021). https://doi.org/10.1007/s10147-020-01791-x

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  • DOI: https://doi.org/10.1007/s10147-020-01791-x

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