SynthesisFrontiers in oncology2026
Prognostic value of prognostic nutritional index in patients with hepatocellular carcinoma undergoing hepatectomy: a systematic review and meta-analysis.
Synthesis in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To evaluate the value of preoperative prognostic nutritional index (PNI) in predicting the long-term survival of patients with hepatocellular carcinoma (HCC) after hepatectomy through systematic review and meta-analysis. Methods: PubMed, Embase, Web of Science, and Cochrane Library were searched to collect observational studies on the association between preoperative PNI and prognosis of HCC patients after hepatectomy from inception to April 2026. Two researchers independently screened the literature and extracted the data, and the Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias of the included studies. A random-effects model was used to evaluate the effect of PNI on overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS). Sensitivity and subgroup analyses were performed to test the stability of the results, and Egger's test was used to assess publication bias. Results: A total of 16 studies were included. The results of the meta-analysis showed that higher preoperative PNI was associated with significantly improved OS (pooled HR = 0.44, 95%CI: 0.29-0.65, P < 0.001) and DFS (pooled HR = 0.67, 95%CI: 0.50-0.90, P = 0.007) and RFS (pooled HR = 0.76, 95%CI: 0.69-0.84, P < 0.001). Sensitivity analysis showed that the pooled results did not change direction after removing individual studies one by one. Egger's test suggested that publication bias may exist in the OS analysis, but the association between PNI and OS remained statistically significant after the correction (adjusted HR = 0.35, 95%CI: 0.17-0.75). Subgroup analysis results suggest that the PNI cutoff may be the one of the source of heterogeneity. Conclusion: Current evidence suggests that a higher preoperative prognostic nutritional index is a potential protective factor for longer overall survival, disease-free survival and recurrence-free survival in patients with HCC after curative hepatectomy. As an easily accessible composite index, PNI may serve as a complementary tool for preoperative risk assessment, but its incremental predictive value over established prognostic models requires further validation in prospective studies. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261389510, identifier CRD420261389510.
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