What question did this study set out to answer?

The aim is to evaluate the prognostic significance of the prognostic nutritional index (PNI) in prostate cancer patients undergoing androgen deprivation therapy (ADT).

March 13, 2026Open Access

Prognostic and clinicopathological value of the prognostic nutritional index in prostate cancer treated with androgen deprivation therapy: a systematic review and meta-analysis

Key Points

The aim is to evaluate the prognostic significance of the prognostic nutritional index (PNI) in prostate cancer patients undergoing androgen deprivation therapy (ADT).
Conducted a systematic review and meta-analysis of relevant literature.
Searched multiple databases including PubMed and Embase up to September 2025.
Calculated pooled hazard ratios (HRs) and odds ratios (ORs) for survival outcomes and clinicopathological features.
Low PNI significantly associated with worse overall survival (HR = 2.082).
Low PNI predicted inferior outcomes in progression-free survival metrics (PFS HR = 1.606, rPFS HR = 2.315, PSA-PFS HR = 3.176).
Low PNI correlated with higher Gleason scores, bone metastasis, and LATITUDE high-risk status, but not with age or visceral metastases.

Abstract

Background The prognostic nutritional index (PNI) has been associated with survival outcomes in multiple solid tumors, yet its prognostic relevance in prostate cancer patients undergoing androgen deprivation therapy (ADT)-based systemic treatment remains insufficiently characterized. Methods We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI) from database inception to September 11, 2025. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were used to assess the association between PNI and survival outcomes; pooled odds ratios (ORs) with 95% CIs evaluated links with clinicopathological features. Subgroup analyses explored heterogeneity sources. Results Ten retrospective studies involving 1, 847 patients were included. Low PNI was significantly associated with worse overall survival (HR = 2.082, 95% CI: 1.756–2.469, p 0.001). Due to heterogeneous definitions of disease progression across studies, progression-related endpoints were analyzed separately by type. Low PNI consistently predicted inferior outcomes across multiple progression-free survival metrics: PFS (HR = 1.606, 95% CI: 1.328–1.942), radiographic PFS (rPFS; HR = 2.315, 95% CI: 1.525–3.514), and PSA-PFS (HR = 3.176, 95% CI: 2.169–4.652) (all p 0.001). Subgroup analyses supported result robustness. Additionally, low PNI correlated significantly with Gleason score 7 (OR = 1.404, p = 0.018), bone metastasis (OR = 1.433, p = 0.015), LATITUDE high-risk status (OR = 1.898, p = 0.003), and CHAARTED-defined high tumor burden (OR = 1.950, p = 0.001), but not with age, visceral metastases, or EAU high-risk classification. Conclusions In the context of ADT-based systemic therapy, low PNI is a significant predictor of poor survival and aggressive disease features, supporting its potential as a readily available biomarker for risk stratification and prognostic assessment in prostate cancer patients. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420251145397.

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