Abstract
BACKGROUND: This meta-analysis aimed to identify the association of prognostic nutritional index (PNI) with long-term survival in lung cancer patients who received the immune checkpoint inhibitors. METHODS: The Medline, CNKI, EMBASE, and Web of Science databases were searched up to August 20, 2023. Progression-free survival (PFS) and overall survival (OS) were main outcomes and hazard ratios (HRs) and 95% confidence intervals were combined. Subgroup analysis stratified by the pathological type [non-small cell lung cancer (NSCLC) vs small cell lung cancer (SCLC)], previous treatment history and combination of other treatment was performed. RESULTS: Twenty-two available studies with 2550 patients were included. Pooled results demonstrated that lower PNI was related to worse PFS (HR = 0.51, P<.001) and OS (HR = 0.43, P<.001). Furthermore, subgroup analysis based on the pathological type (non-small cell lung cancer: HR = 0.52, P<.001 for PFS, HR = 0.41, P<.001 for OS; small cell lung cancer: HR = 0.41, P = .007 for PFS, HR = 0.44, P = .007 for OS), previous treatment history (first-line treatment: HR = 0.67, P<.001 for PFS, HR = 0.52, P<.001 for OS) and combination of other treatment (No: HR = 0.54, P<.001 for PFS, HR = 0.43, P<.001 for OS; Yes: HR = 0.63, P<.001 for PFS, HR = 0.51, P<.001) showed similar findings. CONCLUSION: PNI is significantly associated with long-term survival in immune checkpoint inhibitors treated lung cancer and patients with lower PNI are more likely to experience poorer prognosis.