Comparison of the Prognostic Value of Inflammation-Based Scores in Patients with Hepatocellular Carcinoma After Anti-PD-1 Therapy

Abstract

Background Inflammatory response is related to cancer progression and patient survival. However, the value in predicting survival in hepatocellular carcinoma (HCC) patients who received anti-PD-1 therapy has not been elucidated. This study aimed to compare the predictive ability of inflammation-based scores for the prognosis of HCC patients after anti-PD-1 therapy. Methods A total of 442 patients who received anti-PD-1 therapy were included in the study. Representative inflammation-based prognostic scores, including the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-C-reactive protein (CRP) ratio (LCR), lymphocyte-to-monocyte ratio (LMR), systemic immune inflammation index (SII), CRP-to-albumin ratio (CAR), prognostic nutritional index (PNI), Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), and prognostic index (PI), were assessed for prediction accuracy using Kaplan–Meier survival curves, time-dependent receiver operating characteristic (ROC) and Harrell’s concordance index (C-index) analyses. Results All the inflammation-based prognostic scores exhibited good discriminatory ability in overall survival (OS) (all P < 0.01), while the PNI score was a unique independent predictor for OS in multivariate analysis (hazard ratio, 1.770; confidence interval, 1.309–2.393; P < 0.001). The areas under the ROC curves at 6, 12, 18 and 24 months and the C-index (0.65) demonstrated that the predictive accuracy of the PNI score was superior to that of the other inflammation-based scores. Conclusion The PNI score is a discriminatory prognostic indicator for OS in HCC patients with anti-PD-1 therapy and is superior to the other inflammation-based prognostic scores in terms of predictive ability.

Prognostic value of inflammation‐immunity‐nutrition score in patients with hepatocellular carcinoma treated with anti‐PD‐1 therapy

“… 5 , 15 , 17 , 18 The latest research also suggests that in terms of predictive ability, the PNI score is a discriminatory prognostic indicator for OS in HCC patients with anti‐PD‐1 therapy and was superior to the other inflammation‐based prognostic scores, including Glasgow Prognostic Score (GPS), systemic immune inflammation index (SII), modified Glasgow Prognostic Score (mGPS), prognostic index (PI), CRP‐to‐albumin ratio (CAR), lymphocyte‐to‐monocyte ratio (LMR), and lymphocyte‐to‐CRP ratio (LCR). 6 Different from IINS, most of prognostic biomarkers are different combination of two indexes from serum testing at present, which cannot reflect the immune and nutritive function of the body, in resulting inevitable biases and prediction inaccuracy. 19 …”

“… 21 , 22 Emerging evidence has shown that inflammation‐based prognostic scores exhibited a promising discriminatory ability in predicting prognosis of HCC patients treated with PD‐1 inhibitors. 5 , 6 HsCRP, LYM, and ALB are the major components of inflammation‐based prognostic scores and were found to be closely correlated with inflammation, immunity, and nutrition, respectively. 23 , 24 Previous studies have also reported the prognostic values of hsCRP/LYM, hsCRP/ALB, and PNI for different types of cancer.…”

“…4 Several studies have evaluated that inflammationbased prognostic scores such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and prognostic nutritional index (PNI) are predictive biomarkers in patients with HCC treated with anti-PD-1 therapy, and higher NLR, PLR, and PNI at baseline are associated with shorter OS and treatment failure. 5,6 High-sensitivity C-reactive protein (hsCRP) is the most sensitive protein for the detection of systemic inflammation and is also correlated with the prognosis in HCC. [7][8][9] Lymphocyte (LYM) and albumin (ALB), as two essential components of the inflammationbased prognostic scores, reflect the systemic immune and nutritional status, respectively.…”

“… 10 , 11 Studies have shown that prognostic scores derived from the combination of several of hsCRP, LYM, and ALB were constructed, such as hsCRP/ALB, hsCRP/LYM, PNI, and were superior to individual indicators in terms of predictive ability. 6 , 8 , 9 As a result, Li et al initiated that inflammation‐immunity‐nutrition score (IINS), which was simply based on hsCRP, LYM, and ALB, might be prognostic predictor for patients with resectable colorectal cancer, and high IINS presented treatment failure and poor prognosis. 12 However, the prognostic role of IINS in HCC patients treated with anti‐PD‐1 therapy has not been evaluated.…”

Combining Pre- and Postoperative Lymphocyte–C-Reactive Protein Ratios Can Better Predict Hepatocellular Carcinoma Prognosis After Partial Hepatectomy

“… 8 Therefore, the prognostic value of various preoperative inflammatory indicators has been extensively studied, including preoperative platelet–lymphocyte ratio (PrePLR), preoperative lymphocyte–monocyte ratio (PreLMR), systemic immune inflammation index (PreSII), preoperative derived NLR (PredNLR), and preoperative neutrophil–lymphocyte ratio (PreNLR). 9–13 The preoperative lymphocyte–C-reactive protein ratio (PreLCR) has also recently been identified as a powerful prognostic marker in HCC. 14 , 15 …”