Prognostic Nutritional Index Predicts Outcomes in Hepatocellular Carcinoma Treated with Atezolizumab and Bevacizumab: A Propensity Score-matched Analysis.
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Abstract
Background and aims: The prognostic nutritional index (PNI), calculated from serum albumin and lymphocyte count, reflects a patient's immune-nutritional status and has been proposed as a prognostic marker in hepatocellular carcinoma (HCC). However, its role in advanced HCC patients treated with atezolizumab plus bevacizumab (Ate/Bev) remains unclear. In this study, we aimed to evaluate the prognostic value of PNI in patients receiving first-line Ate/Bev therapy.
Methods: We retrospectively analyzed 362 patients with unresectable HCC who received Ate/Bev between November 2020 and June 2023 across two centers. Based on prior literature, a cutoff of 45 was used to classify patients into low-PNI (<45) and high-PNI (≥45) groups. Propensity score matching was performed to balance baseline characteristics.
Results: After propensity score matching, 130 patients (65 per group) were included in the analysis. The high-PNI group showed a significantly lower incidence of grade ≥ 3 treatment-related adverse events (10.8% vs. 24.6%, p = 0.039), a higher objective response rate (38.4% vs. 20.0%, p = 0.037), and significantly longer overall survival (16.7 vs. 7.9 months, p = 0.009). Although progression-free survival was longer in the high-PNI group (4.8 vs. 3.0 months), the difference was not statistically significant (p = 0.597). Multivariate analysis confirmed that PNI was an independent predictor of overall survival (hazard ratio: 0.574, 95% confidence interval: 0.353-0.933, p = 0.025), after adjusting for vascular invasion, alpha-fetoprotein levels, concurrent therapy, and post-treatment interventions.
Conclusions: PNI is an independent prognostic factor for overall survival in advanced HCC patients treated with Ate/Bev in real-world clinical practice. Incorporating PNI into routine assessments may enhance risk stratification and guide therapeutic decision-making.
背景和目的：由血清白蛋白和淋巴细胞计数计算得出的预后营养指数（PNI）反映了患者的免疫营养状况，已被提出作为肝细胞癌（HCC）的预后指标。然而，其在atezolizumab + bevacizumab （Ate/Bev）治疗的晚期HCC患者中的作用尚不清楚。在这项研究中，我们旨在评估PNI在接受一线Ate/Bev治疗的患者中的预后价值。方法：我们回顾性分析了两个中心在2020年11月至2023年6月期间接受Ate/Bev治疗的362例不可切除的HCC患者。基于先前的文献，采用45的临界值将患者划分为低pni(结果：倾向评分匹配后，130例患者（每组65例）被纳入分析。高pni组≥3级治疗相关不良事件发生率显著降低（10.8% vs. 24.6%, p = 0.039），客观缓解率较高（38.4% vs. 20.0%, p = 0.037），总生存期显著延长（16.7 vs. 7.9个月，p = 0.009）。尽管高pni组的无进展生存期更长（4.8个月vs 3.0个月），但差异无统计学意义（p = 0.597）。多因素分析证实，在调整血管侵入、甲胎蛋白水平、同期治疗和治疗后干预后，PNI是总生存的独立预测因子（风险比：0.574,95%可信区间：0.353-0.933,p = 0.025）。结论：在现实世界的临床实践中，PNI是Ate/Bev治疗晚期HCC患者总生存的独立预后因素。将PNI纳入常规评估可以加强风险分层和指导治疗决策。
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