Post-Treatment Prognostic Nutritional Index Outperforms Baseline Index as an Independent Prognostic Biomarker in
Xiaochun Chen1,2,3, Xinkun Guo1,2,3, Meixia Wang1,4
1Department of Hepatobiliary Oncology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, People's Republic of China.
Purpose:
To investigate the prognostic value of post-treatment prognostic nutritional index (PNI) in advanced hepatocellular carcinoma (HCC) patients treated with immune‑based therapy, and explore its correlation with nutritional-inflammatory markers and treatment response.
Methods:
This retrospective study enrolled 133 patients with unresectable or metastatic HCC who received first- or second-line immune-based regimens (February 2019-September 2022). Patients were stratified by median post-treatment PNI (46.3). Survival was analyzed using Kaplan-Meier and Cox regression methods; subgroup interaction, Spearman correlation, and ROC analyses were also performed.
Results:
Significant baseline differences in Child-Pugh grade, vascular invasion, tumor size, baseline PNI, and median follow-up were observed between groups (all P < 0.05) and adjusted for in multivariate models. Elevated post-treatment PNI independently predicted longer overall survival (median 24.80 vs. 12.27 months, HR = 0.597, 95% CI 0.362-0.983, P = 0.043) and progression-free survival (median 17.07 vs. 7.47 months, HR = 0.558, 95% CI 0.317-0.981, P = 0.043). No significant subgroup interaction was observed for PFS (all interaction P > 0.05); for OS, effect modification was suggested for tumor number (interaction P = 0.036) and AFP level (interaction P = 0.035). Post-treatment PNI positively correlated with albumin (r = 0.862) and lymphocyte count (r = 0.632), and negatively with NLR (r = -0.429) and CRP (r = -0.354). It showed moderate discriminatory ability for objective response (AUC = 0.663). Dynamic change in PNI (ΔPNI) lacked prognostic significance. Median follow-up was 17.2 months.
Conclusion:
Post‑treatment PNI is an independent prognostic biomarker in advanced HCC treated with immune‑based therapy, closely reflecting nutritional-inflammatory status and showing moderate discriminatory ability for treatment response. Dynamic PNI changes provided no incremental prognostic value in this cohort.
