Objective:

To update the prognostic significance of the Prognostic Nutritional Index (PNI) in patients with renal cell carcinoma (RCC) and evaluate its association with survival outcomes based on literature available until October 2023.

Key Findings:

• PNI is associated with overall survival (OS), progression-free survival (PFS), and cancer-specific survival (CSS) in RCC patients, indicating its potential as a prognostic marker.
• Low PNI correlates with advanced tumor stage and poor prognosis, suggesting a need for early intervention.
• Variability in PNI cutoff values across studies limits its clinical applicability, highlighting the need for standardization.

Interpretation:

PNI may serve as a valuable prognostic tool in RCC, reflecting nutritional and immune status; however, its clinical application requires standardized protocols and further validation.

Limitations:

• Most studies included were retrospective with small sample sizes, which may affect the reliability of the findings.
• The variability in PNI cutoff values complicates universal application, necessitating further research to establish standardized thresholds.
• The impact of targeted therapies and immunotherapy on PNI's prognostic value remains unclear, warranting additional investigation.

Conclusion:

This updated meta-analysis supports the prognostic value of PNI in RCC, suggesting its potential role in risk stratification and personalized treatment approaches, which could enhance patient management.