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Pretreatment Prognostic Nutritional Index Predicts Progression-Free Survival in BCLC Stage C Hepatocellular Carcinoma
Umut Aydın1, Mustafa Dikilitaş1, İpek Balıkçı Çiçek2
1Department of Medical Oncology, Faculty of Medicine, İnönü University, Malatya, Turkey.
Background:
Systemic inflammation and nutritional status are key determinants of tumor progression in advanced hepatocellular carcinoma (HCC). This study aimed to evaluate the prognostic significance of inflammation and nutrition based indices in patients with BCLC stage C HCC treated with sorafenib.
Methods:
This retrospective cohort study included 109 patients with Barcelona Clinic Liver Cancer (BCLC) stage C HCC who received sorafenib as first line systemic therapy. A complete-case approach was used for multivariate Cox regression analysis. Progression-free survival (PFS) was defined according to RECIST version 1.1. Kaplan-Meier survival analysis and Cox proportional hazards regression models were used to assess prognostic factors.
Results:
In Kaplan-Meier and univariate Cox analyses, several inflammation- and nutrition-based indices, including NLR, PLR, SII, mGPS, PI, and ALBI grade, were significantly associated with PFS. Although the total cohort included 109 patients, the final multivariate Cox regression model for PNI included 78 complete-case patients. In this model, low prognostic nutritional index (PNI) (HR: 2.36, 95% CI: 1.14-4.87, p=0.020) and prior local ablative treatment (HR: 0.45, 95% CI: 0.24-0.83, p=0.011) remained independently associated with PFS.
Conclusion:
Pretreatment low PNI was independently associated with shorter progression-free survival in patients with BCLC stage C HCC treated with sorafenib. Other inflammation and nutrition-based indices were associated with PFS in univariate analyses but did not retain independent prognostic significance after adjustment. PNI may serve as a simple prognostic marker for risk stratification in real-world settings, although external validation is required.
