Published online Feb 15, 2024. doi: 10.4251/wjgo.v16.i2.514
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
Processing time: 78 Days and 1 Hours
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.
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.
To identify whether the PNI could be used in predicting survival outcomes in patients with GC that are submitted to surgery.
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.
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.
PNI could be an important prognostic marker that could assist in predicting the survival of patients submitted to gastrectomy.
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.