Association between the prognostic nutritional index and prognosis in patients with non-small cell lung cancer undergoing curative lung resection: a systematic review and meta-analysis.

Abstract

To explore the prognostic value of the prognostic nutritional index (PNI) in patients undergoing curative surgery for non-small cell lung cancer (NSCLC) through a systematic review and meta-analysis. Relevant studies published up to October 2025 were searched in PubMed, Embase, Web of Science, and Cochrane. Observational studies assessing the association between PNI and overall, recurrence-free, or cancer-specific survival after curative resection of NSCLC were included. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was evaluated by the I² statistic, with sensitivity analyses and assessment for publication bias. A total of 11 studies were included in the analysis. Meta-analysis indicated that higher PNI significantly associated with longer OS (HR = 0.79, 95% CI: 0.72-0.87, P<0.00001), RFS (HR = 0.64, 95% CI: 0.51-0.80, P<0.0001), and CSS (HR = 0.50, 95% CI: 0.31-0.80, P = 0.004). Substantial heterogeneity was observed in the OS analysis (I²=88%), but the results were robust in sensitivity analyses. Heterogeneity was low in RFS and CSS (I²=34% and 0%). The association with OS did not change significantly after adjustment for publication bias. PNI is an independent prognostic indicator for patients undergoing curative surgery for NSCLC. It provides an economical and convenient tool for risk stratification by integrating nutritional and immune function. It is recommended that PNI be incorporated into the preoperative assessment to guide personalized interventions. Future prospective studies are needed to optimize the PNI cutoff value and explore its synergistic effects with multidisciplinary treatments. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251237417, identifier CRD420251237417.