International Journal of Colorectal Disease

, Volume 34, Issue 4, pp 681–689 | Cite as

Impact of the preoperative prognostic nutritional index on postoperative and survival outcomes in colorectal cancer patients who underwent primary tumor resection: a systematic review and meta-analysis

  • Guangwei Sun
  • Yalun Li
  • Yangjie Peng
  • Dapeng Lu
  • Fuqiang Zhang
  • Xueyang Cui
  • Qingyue Zhang
  • Zhuang LiEmail author
Original Article



We aimed to explore whether the preoperative prognostic nutritional index (PNI) could be an indicator of prognostic outcomes in colorectal cancer (CRC) patients.


A systematic review and meta-analysis was conducted using the PubMed, Embase, and Web of Science databases. All original comparative studies published in English that were related to a high PNI versus a low PNI in CRC patients were included.


A total of 10 studies involving 6372 patients were included in our meta-analysis. Our overall analysis indicated that the low-PNI group had a significantly reduced overall survival (OS) (HR = 1.87, 95% CI = 1.45–2.42, P < 0.01), cancer-specific survival (HR = 1.53, 95% CI = 1.07–2.19, P = 0.02), and disease-free survival (HR = 1.67, 95% CI = 1.23–2.26, P < 0.01) compared with the high-PNI group. Furthermore, our subgroup results indicated that a high PNI could be a significant indicator of improved OS in TNM stage II (HR = 1.93, 95% CI = 1.29–2.90, P < 0.01) and III (HR = 1.71, 95% CI = 1.25–2.34, P < 0.01), and a similar trend in TNM stage I or IV could also be observed though without statistical significance. Regarding postoperative complications, our pooled results indicated that the low-PNI group had a significantly increased incidence of total and severe postoperative complications.


Our findings indicated that CRC patients with a preoperative high PNI had a significantly improved OS. However, almost only Asian CRC patients were included based on current issue.


Prognostic nutritional index Colorectal cancer Complications Overall survival Meta-analysis 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

No informed consent.

Disclosure statement

The authors have nothing to disclose.

Supplementary material

384_2019_3241_MOESM1_ESM.tif (1014 kb)
ESM 1 (TIF 0.98 mb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Anorectal SurgeryThe First Hospital of China Medical UniversityShenyangPeople’s Republic of China

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