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Pretreatment prognostic nutritional index as a prognostic marker in head and neck cancer: a systematic review and meta-analysis.

ABSTRACT: The predictive value of the pretreatment prognostic nutritional index (PNI) for head and neck cancer (HNC) remains controversial. We conducted a meta-analysis to assess the predictive value of PNI in HNC patients. A systematic search through internet databases including PubMed, Embase, and Cochrane Library for qualified studies estimating the association of PNI with HNC patient survival was performed. Overall survival (OS), progression-free survival (PFS), disease-specific survival (DSS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) data were collected and evaluated. A random-effects model was used to calculate the pooled hazard ratios (pHRs) and corresponding 95% confidence intervals (CIs). A total of 7815 HNC patients from 14 eligible studies were involved. Pooled analysis showed that low pretreatment PNI was correlated with poor OS (pHR: 1.93, 95% CI 1.62-2.30, p < 0.001), PFS (pHR: 1.51, 95% CI 1.19-1.92, p = 0.008), DSS (pHR: 1.98, 95% CI 1.12-3.50, p < 0.001), DFS (pHR: 2.20, 95% CI 1.66-2.91, p < 0.001) and DMFS (pHR: 2.04, 95% CI 1.74-2.38, p < 0.001). Furthermore, low pretreatment PNI was correlated with poor OS despite variations in the cancer site, sample size, PNI cut-off value, analysis method (multivariate analysis or univariate analysis) and treatment modality in subgroup analysis. Elevated pretreatment PNI is correlated with a superior prognosis in HNC patients and could be used as a biomarker in clinical practice for prognosis prediction and treatment stratification.

SUBMITTER: Luan CW

PROVIDER: S-EPMC8385102 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundTumor hypoxia plays a fundamental role in resistance to therapy and disease progression. A number of studies have assessed the prognostic role of HIFs expression in head and neck cancer (HNC), but no consistent outcomes are reported.MethodologyA systematical search was performed to search relevant literatures in PubMed, Web of Science and ISI Web of Knowledge databases. The patients' clinical characteristics and survival outcome were extracted. The correlation between HIFs expression and prognosis was analyzed.Principal findingsA total of 28 studies assessed the association between HIFs and HNC survival, the result showed that overexpressed HIFs was significantly associated with increase of mortality risk (HR?=?2.12; 95% CI: 1.52-2.94; I(2) 74%). Subgroup analysis on different HIF isoforms with OS indicated that both HIF-1? and HIF-2? were associated with worse prognosis. The pooled HRs were 1.72(95% CI 1.34-2.20; I(2) 70.7%) and 1.79(95% CI: 1.42-2.27, I(2) 0%). Further subgroup analysis was performed by different geographical locations, disease subtype, stage, types of variate analysis and cut-off value. The results revealed that overexpressed HIF-1? was significantly associated with poor prognosis in Asian patients (HR?=?2.34; 95% CI: 1.76-3.1; I(2) 48.9%), but not in European patients (HR?=?1.13; 95% CI: 0.77-1.66; I(2) 78.3%). Furthermore, HIF-1? overexpression was significantly associated with worse OS in oral carcinoma (HR?=?2.1; 95% CI: 1.11-3.97; I(2) 81.7%), nasopharyngeal carcinoma (HR?=?2.07; 95% CI:1.23-3.49; I(2) 22.5%) and oropharynx carcinoma (HR?=?1.76; 95% CI:1.05-2.97; I(2) 61%), but not in laryngeal carcinoma (HR?=?1.38; 95% CI: 0.87-2.19; I(2) 62.5%). We also found that the prognostic value of HIF-1? overexpression existed only when using staining and percentage as positive definition (HR?=?1.82; 95% CI 1.42-2.33; I(2) 9.9%).ConclusionsThis study showed that overexpressed HIFs were significantly associated with increase of mortality risk. Subgroup analysis revealed that overexpressed HIF-1? was significantly associated with worse prognosis of HNC in Asian countries. Additionally, HIF-1? had different prognostic value in different HNC disease subtypes.

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Pretreatment prognostic nutritional index as a prognostic marker in head and neck cancer: a systematic review and meta-analysis.

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