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
ARTICLE HIGHLIGHTS
Research background

Gastric cancer (GC) is a major health problem worldwide. Patients with GC that are eligible for surgery are submitted to gastrectomy with lymphadenectomy followed or not by adjuvant chemotherapy. It is important to identify prognostic factors that could predict the survival of those patients. The prognostic nutritional index (PNI) is an indicator of the nutritional and immune status of GC patients that could assist in identifying patients that will benefit the most from being submitted to surgery and that will present better survival rates.

Research motivation

GC patients with high preoperative PNI seem to present higher survival rates than those with lower PNI. PNI is easy to calculate and low-cost but in order to be used in everyday clinical practice, future research should be conducted to establish a standardized PNI threshold for GC patients that could be submitted to surgery.

Research objectives

To identify whether the PNI could be used in predicting survival outcomes in patients with GC that are submitted to surgery.

Research methods

We performed a thorough literature search of PubMed, the Cochrane library, and Reference Citation Analysis for cohort studies that included patients with gastric adenocarcinoma who were submitted to gastrectomy. The keywords that we used for our search were “Prognostic nutritional index”, “survival”, and “gastric cancer” in combinations, which lead to the retrieval of 16 studies that matched our inclusion criteria. We performed risk of bias assessment and quality assessment of each individual study and our study was prospectively registered in PROSPERO.

Research results

Our systematic review showed that the PNI could be an important prognostic marker in patients undergoing surgery for gastric adenocarcinoma. All of the studies that we included demonstrated that preoperative PNI is significantly associated with survival in GC patients except for one study which included stage III only gastric adenocarcinoma patients. However, two of the studies that we included showed that PNI is significantly associated with survival in patients with stage III gastric adenocarcinoma. Further studies should aim to identify a standardized PNI threshold for gastric adenocarcinoma patients. Moreover, future studies should analyze the correlation between PNI and the stage of disease and whether PNI is associated with survival regardless of the disease stage.

Research conclusions

PNI could be an important prognostic marker that could assist in predicting the survival of patients submitted to gastrectomy.

Research perspectives

Future research should aim at identifying a standardized PNI cut-off value. Furthermore, the correlation between PNI and tumor stage, Lauren classification, and patients’ clinicopathological characteristics should be analyzed.