Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2024; 16(2): 514-526
Published online Feb 15, 2024. doi: 10.4251/wjgo.v16.i2.514
Prognostic nutritional index in predicting survival of patients with gastric or gastroesophageal junction adenocarcinoma: A systematic review
Stylianos Fiflis, Grigorios Christodoulidis, Menelaos Papakonstantinou, Alexandros Giakoustidis, Stergos Koukias, Paraskevi Roussos, Marina Nektaria Kouliou, Konstantinos Eleftherios Koumarelas, Dimitrios Giakoustidis
Stylianos Fiflis, Menelaos Papakonstantinou, Alexandros Giakoustidis, Stergos Koukias, Paraskevi Roussos, Dimitrios Giakoustidis, First Department of Surgery, General Hospital Papageorgiou, Thessaloniki 56429, Greece
Grigorios Christodoulidis, Marina Nektaria Kouliou, Konstantinos Eleftherios Koumarelas, Department of General Surgery, University Hospital of Larissa, Larissa 41110, Greece
Author contributions: Fiflis S and Papakonstantinou M contributed equally to this work and wrote most of the manuscript; Fiflis S, Papakonstantinou M, and Giakoustidis A designed the research study, performed the research, and analyzed the data; Christodoulidis G offered guidance and assisted as the corresponding author; Koukias S and Roussos P assisted in writing part of the Results and Discussion sections; Kouliou MN and Koumarelas KE assisted in writing part of the Introduction section; Giakoustidis A and Giakoustidis D offered guidance, assisted in writing part of the Discussion section, and performed manuscript revisions; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Grigorios Christodoulidis, PhD, Surgeon, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece. gregsurg@yahoo.gr
Received: November 16, 2023
Peer-review started: November 16, 2023
First decision: December 2, 2023
Revised: December 16, 2023
Accepted: January 15, 2024
Article in press: January 15, 2024
Published online: February 15, 2024
Abstract
BACKGROUND

Gastric cancer is the third most common cause of cancer related death worldwide. Surgery with or without chemotherapy is the most common approach with curative intent; however, the prognosis is poor as mortality rates remain high. Several indexes have been proposed in the past few years in order to estimate the survival of patients undergoing gastrectomy. The preoperative nutritional status of gastric cancer patients has recently gained attention as a factor that could affect the postoperative course and various indexes have been developed. The aim of this systematic review was to assess the role of the prognostic nutritional index (PNI) in predicting the survival of patients with gastric or gastroesophageal adenocarcinoma who underwent gastrectomy with curative intent.

AIM

To investigate the role of PNI in predicting the survival of patients with gastric or gastroesophageal junction adenocarcinoma.

METHODS

A thorough literature search of PubMed and the Cochrane library was performed for studies comparing the overall survival (OS) of patients with gastric or gastroesophageal cancer after surgical resection depending on the preoperative PNI value. The PRISMA algorithm was used in the screening process and finally 16 studies were included in this systematic review. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO).

RESULTS

Sixteen studies involving 14551 patients with gastric or esophagogastric junction adenocarcinoma undergoing open or laparoscopic or robotic gastrectomy with or without adjuvant chemotherapy were included in this systematic review. The patients were divided into high- and low-PNI groups according to cut-off values that were set according to previous reports or by using receiver operating characteristic curve analysis in each individual study. The 5-year OS of patients in the low-PNI groups ranged between 39% and 70.6%, while in the high-PNI groups, it ranged between 54.9% and 95.8%. In most of the included studies, patients with high preoperative PNI showed statistically significant better OS than the low PNI groups. In multivariate analyses, low PNI was repeatedly recognised as an independent prognostic factor for poor survival.

CONCLUSION

According to the present study, low preoperative PNI seems to be an indicator of poor OS of patients undergoing gastrectomy for gastric or gastroesophageal cancer.

Keywords: Prognostic nutritional index, Gastric adenocarcinoma, Gastroesophageal junction cancer, Prognosis, Overall survival

Core Tip: In the present systematic review, we investigated the role of prognostic nutritional index (PNI) in predicting the survival of patients with gastric or gastroesophageal junction adenocarcinoma that were submitted to surgery with or without chemotherapy. PNI is easy to calculate and provides information about the nutritional status of the patients. Low preoperative PNI seems to be associated with worse survival in patients that will undergo surgery for gastric or gastroesophageal junction adenocarcinoma and therefore could be useful for decision making in clinical practice.