SYSTEMATIC REVIEW article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1597965
This article is part of the Research TopicBiomarkers in Head and Neck Cancer: Genomic Insights and Nuclear Medicine InnovationsView all 3 articles
Prognostic Significance of Prognostic Nutritional Index in Patients with Head and Neck Squamous Cell Carcinoma
Provisionally accepted
- Renmin Hospital of Wuhan University, Wuhan, China
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Objective: This study aimed to investigate the relationship between prognostic nutritional index (PNI) and prognosis in patients with head and neck squamous cell carcinoma (HNSCC). Methods: A systematic review was conducted across three major databases—Embase, PubMed, and the Cochrane Library—to identify studies examining the association between PNI and outcomes in HNSCC patients. The search included all records from database inception through January 20, 2025. Outcomes assessed included hazard ratios (HRs) for overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and progression-free survival (PFS), as well as odds ratios (ORs) for objective response rate (ORR) and disease control rate (DCR). Results: A total of 27 articles involving 4,400 patients were included. Patients with low PNI had significantly shorter OS (HR: 2.42, 95% CI: 2.15–2.73, p < 0.001), CSS (HR: 2.05, 95% CI: 1.09–3.84, p = 0.026), DFS (HR: 1.89, 95% CI: 1.58–2.27, p < 0.001), and PFS (HR: 2.23, 95% CI: 1.90–2.62, p < 0.001) compared to those with high PNI. Additionally, low PNI was associated with lower ORR (OR: 0.40, 95% CI: 0.22–0.73, p = 0.002) and DCR (OR: 0.30, 95% CI: 0.17–0.53, p < 0.001). Subgroup analyses confirmed consistent associations between PNI and OS, DFS, and PFS across different Cox models, cancer types, treatment modalities (immune checkpoint inhibitors and surgery), countries, and PNI cut-off values. Conclusion: This study underscores the prognostic significance of PNI in predicting survival outcomes and treatment responses in HNSCC patients. The findings highlight the importance of incorporating PNI into routine prognostic assessments to improve clinical decision-making and patient management in HNSCC.
Keywords: Prognostic nutritional index, Head and neck squamous cell carcinoma, prognosis, Overall survival (OS), Disease-free survival (DFS)
Received: 22 Mar 2025; Accepted: 24 Jul 2025.
Copyright: © 2025 Wang, Wang, Xiao, Wang, Huang, Jiang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tianyi Liu, Renmin Hospital of Wuhan University, Wuhan, China
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