Predictive value of prognostic nutritional index for outcomes of cervical cancer: A systematic review and meta‑analysis

Cao,Dan; Cao,Dan; Dong,Qiyin; Dong,Qiyin

doi:10.3892/etm.2024.12605

Predictive value of prognostic nutritional index for outcomes of cervical cancer: A systematic review and meta‑analysis

Authors:
- Dan Cao
- Qiyin Dong
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Affiliations: Department of Gynaecology, Huzhou Maternity and Child Care Hospital, Huzhou, Zhejiang 313000, P.R. China, Reproductive Center, Huzhou Maternity and Child Care Hospital, Huzhou, Zhejiang 313000, P.R. China
Published online on: June 11, 2024 https://doi.org/10.3892/etm.2024.12605
Article Number: 316
Copyright: © Cao et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Cervical cancer is a major global health concern. Prognostic markers for cervical cancer have traditionally focused on tumor characteristics. However, there is a growing recognition of the importaxnce of the nutritional status of the patient as a possible prognostic indicator. The present meta‑analysis aims to estimate the role of the prognostic nutritional index (PNI) in predicting overall survival (OS) and progression‑free survival (PFS) in patients with cervical cancer. Medline, Google Scholar, Science Direct and Cochrane Central databases were systematically searched for studies reporting PNI in patients with cervical cancer. Inclusion criteria were applied to select relevant studies and data extraction was performed by two independent investigators. Risk of bias was assessed by the Newcastle‑Ottawa Scale (NOS). The present meta‑analysis included 10 studies with 2,352 participants. The pooled analysis showed that in patients with cervical cancer PNI did not have a significant prognostic utility in predicting OS [univariate hazard ration (HR): 1.38; 95% confidence interval (CI): 0.77‑2.48) or PFS (univariate HR: 1.12; 95% CI: 0.44‑2.68). These results were consistent even after adjusting for other confounders using multivariate analysis (pooled HR: 1.06 for OS; 95% CI: 0.64‑1.76; pooled HR: 1.22 for PFS; 95% CI: 0.65‑2.30). Subgroup analyses were also performed based on region, PNI cut‑off, sample size, grade of evidence and treatment protocol and did not demonstrate any significant prognostic value of PNI. The funnel plot demonstrated symmetry, suggesting the absence of publication bias. The present meta‑analysis indicated that PNI does not have a significant prognostic utility in predicting OS or PFS in women with cervical cancer. Further research is warranted to explore alternative nutritional indicators and identify reliable prognostic markers in this patient population.

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