Abstract
PURPOSE: To identify the predictive role of the preoperative prognostic nutritional index (PNI) for long-term survival in patients undergoing pancreatoduodenectomy. METHODS: The PubMed, EMBASE, Web of Science, Cochrane Library and CNKI databases were searched up to October 28, 2024. The primary outcomes included overall survival (OS) and disease-free survival (DFS). Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and subgroup analyses by country, type of cancer and source of HR were performed. RESULTS: Fifteen studies with 2106 patients were included. The pooled results demonstrated that a lower preoperative PNI was related to poorer OS (HR = 1.60, 95% CI: 1.38-1.86, P < 0.001) and DFS (HR = 1.44, 95% CI: 1.00-2.07, P = 0.051). Subgroup analysis stratified by country (China vs. non-China), type of cancer (pancreatic cancer vs. nonpancreatic cancer vs. mixed) and source of HR (univariate vs. multivariate analysis) revealed similar results. CONCLUSION: On the basis of the available evidence, the preoperative PNI might serve as a novel prognostic indicator in patients undergoing pancreatoduodenectomy, with a lower PNI predicting worse survival. However, more high-quality studies are needed to further verify the above findings.