预后营养指数与癌症预后的关联研究:一项伞状评价

Association of prognostic nutrition index with cancer prognosis:an umbrella assessment

目的确定不同癌症患者术前预后营养指数(prognostic nutritional index,PNI)水平对其预后相关结局的影响。方法系统检索PubMed、Web of Science、EMBASE和The Cochrane Library从建库到2022年11月1日电子数据库,筛选符合纳入排除标准的有关PNI与癌症预后相关结局之间关联的meta分析,使用AMSTAR 2评估所纳入meta分析的证据强度,再基于统计分析结果,评估证据的可信度等级。结果共纳入15篇meta分析,AMSTAR 2评价结果显示,8篇研究质量被评价为“高”、6篇评为“中”,1篇评为“低”。从15项meta分析中提取8项预后结局指标进行分析,结果显示,低PNI水平与多种肿瘤的总生存期(overall survival,OS)、无进展生存期(progression-free survival,PFS)、无病生存期(disease-free survival,DFS)、癌症特异性生存期(cancer-specific survival,CSS)、疾病特异性生存(disease-specific survival,DSS)、无远处转移生存期(distant metastasis-free survival,DMFS)的减短有关。此外,较低PNI水平还与较高癌症复发风险有关。癌症预后结局指标的证据评价中,较低的PNI值对癌症OS、PFS、DFS、CSS、DSS和复发是有害的,但证据可信度较弱。低PNI值DMFS的有害证据可信度较高。结论低PNI值会增加大多数癌症预后相关不良事件的发生风险。

Objective To determine the impacts of preoperative prognostic nutritional index(PNI)levels on prognosis-related outcomes in patients with different cancers.Methods The electronic databases of PubMed,Web of Science,EMBASE,and the Cochrane Library were systematically searched from inception up to January 1,2022,to retrieve meta-analyses.Eligible studies focusing on the associations between PNI and prognosis-related outcomes in cancers that met the inclusion and exclusion criteria were included in the analysis.We measured the strength of the evidence using the AMSTAR 2,a measurement tool to assess systematic reviews,version 2,and assessed the credibility rating of the evidence based on the results of statistical analyses.Results A total of 15 meta-analyses were included,and the assessment results of AMSTAR 2 showed that eight studies were rated as“high”,six as"medium"and one as"low"in terms of methodological quality.Eight prognostic outcome indicators were extracted from 15 included meta-analyses,and the results revealed that low PNI levels were associated with reduced levels of overall survival(OS),progression-free survival(PFS),disease-free survival(DFS),cancer-specific survival(CSS),disease-specific survival(DSS),and distant metastasis-free survival(DMFS)in a variety of cancers.In addition,lower PNI levels were associated with a higher risk of cancer recurrence.In the evaluation of evidence for cancer prognostic outcome indicators,lower PNI values were harmful to OS,PFS,DFS,CSS,DSS and recurrence of cancers,but the confidence in the evidence was weak.The confidence in the evidence for harmfulness of low PNI values to DMFS was higher.Conclusion Low PNI values can increase the risk of occurrence of most cancer prognosis-related adverse events.