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Meta-Analysis
. 2021 Sep 14;16(9):e0257425.
doi: 10.1371/journal.pone.0257425. eCollection 2021.

Prognostic role of the prognostic nutritional index (PNI) in patients with head and neck neoplasms undergoing radiotherapy: A meta-analysis

Yujie Shi  1 , Yue Zhang  1 , Yaling Niu  1 , Yingjie Chen  1 , Changgui Kou  1
Affiliations
Meta-Analysis

Prognostic role of the prognostic nutritional index (PNI) in patients with head and neck neoplasms undergoing radiotherapy: A meta-analysis

Yujie Shi et al. PLoS One. .

Abstract

Background: This novel meta-analysis was conducted to systematically and comprehensively evaluate the prognostic role of the pretreatment PNI in patients with head and neck neoplasms (HNNs) undergoing radiotherapy.

Methods: Three databases, PubMed, Embase, and Web of Science, were used to retrieve desired literature. Hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted and pooled by fixed-effects or random-effects models to analyze the relationship between the PNI and survival outcomes: overall survival (OS), distant metastasis-free survival (DMFS), and progression-free survival (PFS).

Results: Ten eligible studies involving 3,458 HNN patients were included in our analysis. The robustness of the pooled results was ensured by heterogeneity tests (I2 = 22.6%, 0.0%, and 0.0% for OS, DMFS, and PFS, respectively). The fixed-effects model revealed a lower pretreatment PNI was significantly related to a worse OS (HR = 1.974; 95% CI: 1.642-2.373; P<0.001), DMFS (HR = 1.959; 95% CI: 1.599-2.401; P<0.001), and PFS (HR = 1.498; 95% CI: 1.219-1.842; P<0.001). The trim-and-fill method (HR = 1.877; 95% CI: 1.361-2.589) was also used to prove that the existing publication bias did not deteriorate the reliability of the relationship.

Conclusion: The pretreatment PNI is a promising indicator to evaluate and predict the long-term prognostic survival outcomes in HNN patients undergoing radiotherapy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of study selection procedure.
Fig 2
Fig 2
Forest plots of the relationship between the PNI and survival outcomes: A. OS B. DMFS C. PFS.
Fig 3
Fig 3
Sensitivity analyses of HRs: A. OS B. DMFS C. PFS.
Fig 4
Fig 4
Test results of publication bias: A. before trim-and-fill method B. after trim-and-fill method.
See this image and copyright information in PMC

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