Frontiers in oncology · 2026
Prognostic and clinicopathological value of the prognostic nutritional index in prostate cancer treated with androgen deprivation therapy: a systematic review and meta-analysis.
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Huang Huanli, Hu Jun, Lan Xingwei, Li Hanxiao, Chen Jingru
Аннотация
BACKGROUND: The prognostic nutritional index (PNI) has been associated with survival outcomes in multiple solid tumors, yet its prognostic relevance in prostate cancer patients undergoing androgen deprivation therapy (ADT)-based systemic treatment remains insufficiently characterized.
METHODS: We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI) from database inception to September 11, 2025. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were used to assess the association between PNI and survival outcomes; pooled odds ratios (ORs) with 95% CIs evaluated links with clinicopathological features. Subgroup analyses explored heterogeneity sources.
RESULTS: Ten retrospective studies involving 1, 847 patients were included. Low PNI was significantly associated with worse overall survival (HR = 2.082, 95% CI: 1.756-2.469, p < 0.001). Due to heterogeneous definitions of disease progression across studies, progression-related endpoints were analyzed separately by type. Low PNI consistently predicted inferior outcomes across multiple progression-free survival metrics: PFS (HR = 1.606, 95% CI: 1.328-1.942), radiographic PFS (rPFS; HR = 2.315, 95% CI: 1.525-3.514), and PSA-PFS (HR = 3.176, 95% CI: 2.169-4.652) (all p < 0.001). Subgroup analyses supported result robustness. Additionally, low PNI correlated significantly with Gleason score >7 (OR = 1.404, p = 0.018), bone metastasis (OR = 1.433, p = 0.015), LATITUDE high-risk status (OR = 1.898, p = 0.003), and CHAARTED-defined high tumor burden (OR = 1.950, p = 0.001), but not with age, visceral metastases, or EAU high-risk classification.
CONCLUSIONS: In the context of ADT-based systemic therapy, low PNI is a significant predictor of poor survival and aggressive disease features, supporting its potential as a readily available biomarker for risk stratification and prognostic assessment in prostate cancer patients.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420251145397.
METHODS: We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI) from database inception to September 11, 2025. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were used to assess the association between PNI and survival outcomes; pooled odds ratios (ORs) with 95% CIs evaluated links with clinicopathological features. Subgroup analyses explored heterogeneity sources.
RESULTS: Ten retrospective studies involving 1, 847 patients were included. Low PNI was significantly associated with worse overall survival (HR = 2.082, 95% CI: 1.756-2.469, p < 0.001). Due to heterogeneous definitions of disease progression across studies, progression-related endpoints were analyzed separately by type. Low PNI consistently predicted inferior outcomes across multiple progression-free survival metrics: PFS (HR = 1.606, 95% CI: 1.328-1.942), radiographic PFS (rPFS; HR = 2.315, 95% CI: 1.525-3.514), and PSA-PFS (HR = 3.176, 95% CI: 2.169-4.652) (all p < 0.001). Subgroup analyses supported result robustness. Additionally, low PNI correlated significantly with Gleason score >7 (OR = 1.404, p = 0.018), bone metastasis (OR = 1.433, p = 0.015), LATITUDE high-risk status (OR = 1.898, p = 0.003), and CHAARTED-defined high tumor burden (OR = 1.950, p = 0.001), but not with age, visceral metastases, or EAU high-risk classification.
CONCLUSIONS: In the context of ADT-based systemic therapy, low PNI is a significant predictor of poor survival and aggressive disease features, supporting its potential as a readily available biomarker for risk stratification and prognostic assessment in prostate cancer patients.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420251145397.