Post-Treatment Prognostic Nutritional Index Outperforms Baseline Index as an Independent Prognostic Biomarker in Advanced Hepatocellular Carcinoma Receiving Immune-Based Systemic Therapy.
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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.