Research Paper Volume 15, Issue 5 pp 1615—1627

Prognostic and clinicopathological significance of prognostic nutritional index (PNI) in patients with oral cancer: a meta-analysis

Menglu Dai1, , Qijun Sun2, ,

  • 1 Clinical Laboratory, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou 313000, Zhejiang, China
  • 2 Stomatology Therapeutic Center, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou 313000, Zhejiang, China

Received: July 12, 2022       Accepted: February 13, 2023       Published: March 7, 2023
How to Cite

Copyright: © 2023 Dai and Sun. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Accumulating literature has explored how prognostically significant the prognostic nutritional index (PNI) was for the oral carcinoma population, but with inconsistent findings. Therefore, we retrieved the most recent data and carried out this meta-analysis to comprehensively analyze the prognostic performance of pretreatment PNI in oral cancer. The electronic databases of PubMed, Embase, China National Knowledge Infrastructure (CNKI), Cochrane Library and Web of Science were fully retrieved. PNI’s prognostic value for survival outcomes in oral carcinoma was assessed by estimating pooled hazard ratios (HRs) plus 95% confidence intervals (CIs). We examined the correlation of PNI with clinicopathological traits of oral carcinoma by utilizing the pooled odds ratios (ORs) plus 95% CIs. According to the pooled results of the present meta-analysis, which enrolled 10 studies involving 3,130 patients, for oral carcinoma suffers whose PNI was low, their disease-free survival (DFS) (HR=1.92, 95%CI=1.53-2.42, p<0.001) and overall survival (OS) (HR=2.44, 95%CI=1.45-4.12, p=0.001) would be inferior. Nonetheless, cancer-specific survival (CSS) was not linked significantly to PNI for the oral carcinoma population (HR=1.89, 95%CI=0.61-5.84, p=0.267). Significant associations of low PNI with TNM stages III-IV (OR=2.16, 95%CI=1.60-2.91, p<0.001) and age ≥ 65 years (OR=2.29, 95%CI=1.76-2.98, p<0.001) were found. As suggested by the present meta-analysis, a low PNI was linked to inferior DFS and OS among oral carcinoma patients. Oral cancer patients with low PNI may have high-risk of tumor progression. PNI could be served as a promising and effective index to predict prognosis in patients with oral cancer.


PNI: prognostic nutritional index; HRs: hazard ratios; CIs: confidence intervals; CNKI: China National Knowledge Infrastructure; ORs: odds ratios; OS: overall survival; DFS: disease-free survival; CSS: cancer-specific survival; OSCC: oral squamous cell carcinoma; CRT: chemoradiotherapy; ICIs: immune checkpoint inhibitors; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; TNM: Tumor–Node–Metastasis; NOS: Newcastle-Ottawa Scale; TILs: tumor-infiltrating lymphocytes; PFS: progression-free survival; PICOS: populations, interventions, comparators, outcomes, and study designs.