Prognostic and Clinicopathological Correlations of Pretreatment Prognostic Nutritional Index in Renal Cell Carcinoma: A Meta-Analysis

Prognostic nutritional index (PNI) was indicted as a potential prognostic biomarker for cancer. However, the conclusion remains uncertain for renal cell carcinoma (RCC). This study was to confirm the association of PNI with prognosis and clinicopathological features in RCCs.The PubMed, EMBASE, Cochrane Library, CNKI, and Wan Fang databases were searched to retrieve eligible studies. Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled to assess the strength of the association.Fifteen studies were included. The results showed a low pretreatment PNI level was significantly associated with poor overall survival (HR = 1.67, 95% CI: 1.45-1.92), progression-free survival (HR = 1.72, 95% CI: 1.23-2.42), cancer-specific survival (HR = 1.17, 95% CI: 1.09-1.26), disease-free survival (HR = 1.28, 95% CI: 1.09-1.26), and recurrence-free survival (HR = 2.14, 95% CI: 1.38-3.31). This prognostic role of PNI was almost not changed by subgroup analysis based on study design, HR source, RCC type, sample size, cutoff, follow-up, treatment, and country. Furthermore, low PNI was correlated with old age, large tumor size and high T stage, Fuhrman grade, lymph node, and distant metastases.Pretreatment PNI might be a promising indicator to beforehand predict the progression and prognosis for RCC patients.