Prognostic Role of Prognostic Nutritional Index in Patients with Bladder Cancer: a Systematic Review and Meta-analysis

Overview

Journal Front Oncol

Date 2025 Feb 7

PMID 39917365

Authors

Jing Sun

Zhenzhen Li

Xiaming Zhu

Affiliations

Soon will be listed here.

Abstract

Aims: An increasing number of studies have explored the prognostic significance of the prognostic nutritional index (PNI) in bladder cancer patients, but the results are inconsistent. This study systematically investigates the prognostic value of baseline PNI in patients with bladder cancer through a meta-analytic approach.

Methods: The databases of PubMed, EmBase, and the Cochrane library were systematically searched for eligible studies from inception until April 2024. The prognostic outcomes including overall survival (OS) and recurrence-free survival (RFS). The summary outcomes were calculated using the random-effects model, and the exploratory analyses were performed by sensitivity and subgroup analyses.

Results: Twelve retrospective studies involved 2,951 patients with bladder cancer were selected in final analysis. The summary results found low PNI were associated with poor OS (HR: 1.80; 95%CI: 1.54-2.10; <0.001) and RFS (HR: 1.53; 95%CI: 1.15-2.04; =0.003). The association between low PNI and shorter OS was statistically significant in all subgroups. Additionally, the association between low PNI and RFS was also significant in most subgroups.

Conclusions: This study found a significant association between low PNI and poor prognosis in bladder cancer patients. Further large-scale prospective study should be performed to verify this association, and assess the nutrition interventions for patients with bladder cancer.

Systematic Review Registration: https://inplasy.com/inplasy-2024-8-0020/, identifier INPLASY202480020.

References

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

Claps F, Biasatti A, Di Gianfrancesco L, Ongaro L, Giannarini G, Pavan N . The Prognostic Significance of Histological Subtypes in Patients with Muscle-Invasive Bladder Cancer: An Overview of the Current Literature. J Clin Med. 2024; 13(15). PMC: 11313590. DOI: 10.3390/jcm13154349. View

Chamie K, Litwin M, Bassett J, Daskivich T, Lai J, Hanley J . Recurrence of high-risk bladder cancer: a population-based analysis. Cancer. 2013; 119(17):3219-27. PMC: 3773281. DOI: 10.1002/cncr.28147. View

Mohri Y, Inoue Y, Tanaka K, Hiro J, Uchida K, Kusunoki M . Prognostic nutritional index predicts postoperative outcome in colorectal cancer. World J Surg. 2013; 37(11):2688-92. DOI: 10.1007/s00268-013-2156-9. View

Cahn D, Handorf E, Ghiraldi E, Ristau B, Geynisman D, Churilla T . Contemporary use trends and survival outcomes in patients undergoing radical cystectomy or bladder-preservation therapy for muscle-invasive bladder cancer. Cancer. 2017; 123(22):4337-4345. DOI: 10.1002/cncr.30900. View

Forget P, Echeverria G, Giglioli S, Bertrand B, Nikis S, Lechat J . Biomarkers in immunonutrition programme, is there still a need for new ones? A brief review. Ecancermedicalscience. 2015; 9:546. PMC: 4494817. DOI: 10.3332/ecancer.2015.546. View

Thompson S, Higgins J . How should meta-regression analyses be undertaken and interpreted?. Stat Med. 2002; 21(11):1559-73. DOI: 10.1002/sim.1187. View

Stroman L, Nair R, Russell B, Malik N, Desai A, Chandra A . The impact of non-urothelial variant histology on oncological outcomes following radical cystectomy. BJU Int. 2019; 124(3):418-423. DOI: 10.1111/bju.14704. View

Yu J, Hong B, Park J, Hwang J, Kim Y . Impact of Prognostic Nutritional Index on Postoperative Pulmonary Complications in Radical Cystectomy: A Propensity Score-Matched Analysis. Ann Surg Oncol. 2020; 28(3):1859-1869. PMC: 7415333. DOI: 10.1245/s10434-020-08994-6. View

10.

Zhong X, Pan Y, Wu K, Wang L, Dou P, Tan P . A novel nomogram based on body composition and nutritional indicators to predict the prognosis of patients with muscle-invasive bladder cancer undergoing radical cystectomy. Cancer Med. 2023; 12(24):21627-21638. PMC: 10757150. DOI: 10.1002/cam4.6712. View

11.

Moschini M, DAndrea D, Korn S, Irmak Y, Soria F, Comperat E . Characteristics and clinical significance of histological variants of bladder cancer. Nat Rev Urol. 2017; 14(11):651-668. DOI: 10.1038/nrurol.2017.125. View

12.

Claps F, Mir M, van Rhijn B, Mazzon G, Soria F, DAndrea D . Impact of the controlling nutritional status (CONUT) score on perioperative morbidity and oncological outcomes in patients with bladder cancer treated with radical cystectomy. Urol Oncol. 2022; 41(1):49.e13-49.e22. DOI: 10.1016/j.urolonc.2022.09.023. View

13.

Teke K, Avci I, Cinar N, Baynal E, Bosnali E, Polat S . Immune-inflammatory-nutritional status predicts oncologic outcomes after radical cystectomy for urothelial carcinoma of bladder. Actas Urol Esp (Engl Ed). 2023; 47(7):430-440. DOI: 10.1016/j.acuroe.2023.01.001. View

14.

Herzog I, Panchal D, Sikder S, Park J, Mendiratta D, Mansukhani P . Malnutrition in Head and Neck Free Flap Reconstruction as a Predictor of Adverse Outcomes. Ann Plast Surg. 2024; 92(4S Suppl 2):S251-S254. DOI: 10.1097/SAP.0000000000003868. View

15.

Bi H, Shang Z, Jia C, Wu J, Cui B, Wang Q . Predictive Values of Preoperative Prognostic Nutritional Index and Systemic Immune-Inflammation Index for Long-Term Survival in High-Risk Non-Muscle-Invasive Bladder Cancer Patients: A Single-Centre Retrospective Study. Cancer Manag Res. 2020; 12:9471-9483. PMC: 7534864. DOI: 10.2147/CMAR.S259117. View

16.

Cumberbatch M, Noon A . Epidemiology, aetiology and screening of bladder cancer. Transl Androl Urol. 2019; 8(1):5-11. PMC: 6414346. DOI: 10.21037/tau.2018.09.11. View

17.

Pettit M, Crowder S, Ackerman R, Hafez O, Poch M, Patel S . Preoperative Nutritional Status and Enhanced Recovery after Surgery (ERAS) Prior to Radical Cystectomy: A Review of the Literature. Nutr Cancer. 2023; 75(9):1743-1751. DOI: 10.1080/01635581.2023.2244172. View

18.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

19.

Hamilton-Reeves J, Bechtel M, Hand L, Schleper A, Yankee T, Chalise P . Effects of Immunonutrition for Cystectomy on Immune Response and Infection Rates: A Pilot Randomized Controlled Clinical Trial. Eur Urol. 2015; 69(3):389-92. PMC: 4793712. DOI: 10.1016/j.eururo.2015.11.019. View

20.

Begg C, Mazumdar M . Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994; 50(4):1088-101. View