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Meta-Analysis
. 2016 Sep 6;7(36):58543-58552.
doi: 10.18632/oncotarget.10148.

Prognostic significance of preoperative prognostic nutritional index in colorectal cancer: results from a retrospective cohort study and a meta-analysis

Yuchong Yang  1 , Peng Gao  1 , Xiaowan Chen  1 , Yongxi Song  1 , Jinxin Shi  1 , Junhua Zhao  1 , Jingxu Sun  1 , Yingying Xu  2 , Zhenning Wang  1
Affiliations
Meta-Analysis

Prognostic significance of preoperative prognostic nutritional index in colorectal cancer: results from a retrospective cohort study and a meta-analysis

Yuchong Yang et al. Oncotarget. .

Abstract

The preoperative prognostic nutritional index (PNI) may forecast colorectal cancer (CRC) outcomes, but the evidence is not conclusive. Here, we retrospectively analyzed a cohort of patients from the Department of Surgical Oncology at the First Hospital of China Medical University (CMU-SO). We also conducted a meta-analysis of eleven cohort studies. Bayesian Information Criterion (BIC) was used to determine the optimal PNI cut-off values for classifying prognosis in the patients from the CMU-SO. The result from CMU-SO and meta-analysis both confirmed that low PNI was significantly associated with a poor prognosis and advanced TNM stages. Among the patients from the CMU-SO, the optimal cut-off values were "41-45-58" (PNI < 41, 41 ≤ PNI < 45, 45 ≤ PNI < 58, PNI ≥ 58), which divided patients into 4 stages. The BIC value for TNM staging combined with the PNI was smaller than that of TNM staging alone (-325.76 vs. -310.80). In conclusion, low PNI was predictive of a poor prognosis and was associated with clinicopathological features in patients with CRC, and the 41-45-58 four-stage division may be suitable for determining prognosis. PNI may thus provide an additional index for use along with the current TNM staging system to determine more accurate CRC prognoses.

Keywords: TNM staging; colorectal cancer; meta-analysis; prognosis; prognostic nutritional index.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1. Kaplan-Meier analysis of survival based on low and high prognostic nutritional index among patients from CMU-SO
A. overall survival; B. cancer-specific survival.
Figure 2
Figure 2. Kaplan-Meier analysis of the overall survival (OS) and cancer-specific survival (CSS) based on low and high prognostic nutritional index among patients from CMU-SO with stage I
(A., OS, P = 0.101; CSS, P = 0.002), stage II (B., OS, P < 0.001; CSS, P < 0.001), stage III (C., OS, P = 0.046; CSS, P = 0.058) and stage IV (D., OS, P = 0.757; CSS, P = 0.841).
Figure 3
Figure 3. Meta-analysis of the association between low prognostic nutritional index and survival in CRC
A. overall survival; B. cancer-specific survival.
Figure 4
Figure 4. The smallest Bayesian Information Criterion values of overall survival and cancer-specific survival for a different number of stage divisions (from two to five divisions)
Figure 5
Figure 5. Kaplan-Meier analysis of the overall survival (OS) and cancer-specific survival (CSS) for a different number of stage divisions which indicated smallest Bayesian Information Criterion value (two-stage division see Figure 1)
A. 41-46 three-stage division; B. 41-45-58 four-stage division; C. five-stage division (OS, 35-41-45-57 four-stage division; CSS, 35-41-46-58 four-stage division)
See this image and copyright information in PMC

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