The Prognostic Role of Prognostic Nutritional Index and Controlling Nutritional Status in Predicting Survival in Older Adults with Oncological Disease: A Systematic Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this systematic review that I found very interesting. In addition this topic is very important and deserves further research.

As nutritional screening tools, PNI and CONUT score have became very popular. However, "malnutrition" and/or "risk of malnutrition" should be discussed in more depth. In fact, this part is not adequately discussed in the Discussion section.

Did the authors consider also performing a meta-analysis for PNI and CONUT score? A systematic review and meta-analysis (doi: 10.1016/j.numecd.2023.05.012) recently demonstrated the prognostic role of CONUT score in stroke patients. Similarly, adding this analysis may further improve the present paper. 

Comments on the Quality of English Language

The paper requires minor editing of language 

Author Response

• Comments and Suggestions for Authors

Thank you for the opportunity to review this systematic review that I found very interesting. In addition this topic is very important and deserves further research.

R: Thank you for your interest and availability to review our work. Changes done in the manuscript as a result of reviewers’ comments/suggestions are highlighted in yellow.

 

As nutritional screening tools, PNI and CONUT score have became very popular. However, "malnutrition" and/or "risk of malnutrition" should be discussed in more depth. In fact, this part is not adequately discussed in the Discussion section.

R: Thank you for alerting us to this issue. This section was revised to include a discussion on the topic suggested. Accordingly, the first paragraph of the discussion section reflects this change in the text.

 

Did the authors consider also performing a meta-analysis for PNI and CONUT score? A systematic review and meta-analysis (doi: 10.1016/j.numecd.2023.05.012) recently demonstrated the prognostic role of CONUT score in stroke patients. Similarly, adding this analysis may further improve the present paper.

R: Thank you bringing up this question. We initially considered performing a meta-analysis, since it could summarize the predictive value of PNI and/or CONUT to, at least, overall survival. However, we soon realized that our corpus was substantially heterogeneous, particularly in terms of cancer types and controls used in individual studies. Hence, since we could not guarantee a relatively homogenous sample to include in a meta-analysis, we only developed a systematic review.

 

 

• Comments on the Quality of English Language

The paper requires minor editing of language.

R: Thank you. We have revised the language used in the manuscript and highlighted the main changes.

Reviewer 2 Report

Comments and Suggestions for Authors

The present study provides a systematic review of the prognostic role of PNI (prognostic Nutritional Index) and CONUT (Controlling Nutritional Status) for survival in older adults with oncological diseases. The topic is timely and important due to the significant increase in several forms of cancer associated with obesity in both genders. 

For the study, 210 records were identified. A proper selection criteria sequence is provided in FIg. 1 whereby the authors ended with about 38 reviews included in the study.The majority of the studies selected were retrospective whereas only two were prospective cohorts. The geographical distribution of the studies is provided. PNI Was used in 36 studies whereas CONUT was used in eight studies. THe  independent association of PNI with OS was found to be significant in 23 studies, mainly for gastric cancer, although other forms of cancer presented with an occasional significance. The general conclusion of the study is that despite a high heterogeneity between studies most concluded that low PNI values were associated with poor overall survival (OS) The study also found that the prognostic value of CONUT was inconclusive, perhaps in part due to the low number of studies that used this criterion. 

The study is properly conducted and the conclusions are consistent with the data presented. The manuscript is properly written and can be followed easily. 

Author Response

• Comments and Suggestions for Authors

The present study provides a systematic review of the prognostic role of PNI (prognostic Nutritional Index) and CONUT (Controlling Nutritional Status) for survival in older adults with oncological diseases. The topic is timely and important due to the significant increase in several forms of cancer associated with obesity in both genders. 

For the study, 210 records were identified. A proper selection criteria sequence is provided in FIg. 1 whereby the authors ended with about 38 reviews included in the study.The majority of the studies selected were retrospective whereas only two were prospective cohorts. The geographical distribution of the studies is provided. PNI Was used in 36 studies whereas CONUT was used in eight studies. THe  independent association of PNI with OS was found to be significant in 23 studies, mainly for gastric cancer, although other forms of cancer presented with an occasional significance. The general conclusion of the study is that despite a high heterogeneity between studies most concluded that low PNI values were associated with poor overall survival (OS) The study also found that the prognostic value of CONUT was inconclusive, perhaps in part due to the low number of studies that used this criterion. 

The study is properly conducted and the conclusions are consistent with the data presented. The manuscript is properly written and can be followed easily.

R: Thank you so much for your kind words.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The authors reply to all my comments, therefore I have no other comments. The paper can be accepted in the current form.

Comments on the Quality of English Language

English quality is fine.