Prognostic Nutritional Index and Neutrophil/Lymphocyte Ratio Can Serve as Independent Predictors of the Prognosis of Hepatocellular Carcinoma Patients Receiving Targeted Therapy

Abstract

Objective. The prognostic nutritional index (PNI) is an immunonutritional indicator, and the neutrophil/lymphocyte ratio (NLR) reflects the inflammatory status. This research intends to determine the implications of NLR and PNI in evaluating the outcome of hepatocellular carcinoma (HCC) patients undergoing targeted therapy (TT). Methods. We retrospectively analyzed 83 patients’ records with sorafenib treatment for advanced HCC in the Second Affiliated Hospital of Anhui Medical University. Patient records comprised general data and blood routines. The PNI and NLR values were calculated using the serum albumin levels (ALB), neutrophil (NEU) count, and lymphocyte (LY) count. The optimal thresholds of the PNI and NLR for predicting HCC patients’ outcomes were calculated by X-tile. Patients were further assigned to low- and high-groups of PNI and NLR according to their thresholds. By using the Cox proportional hazards regression models, univariate and multivariate analyses were conducted to identify risk factors influencing the patient's prognosis. Results. The participants were assigned to the corresponding low-PNI (≤42.9; n = 10) and high-PNI (>42.9; n = 73) groups, as well as low-NLR (≤2.4; n = 64) and high-NLR (>2.4; n = 19) groups based on the critical values of PNI (42.9) and NLR (2.4) obtained through the X-tile calculation. A higher overall survival (OS) rate was observed in the high-PNI group and low-NLR group, than in the low-PNI group and high-NLR group, respectively. The disease control rate showed no evident difference between the groups. The PNI and NLR were of high reliability in predicting the OS of patients. Cox multivariate analysis identified the independence of the PNI and NLR as prognostic factors for patients receiving TT for advanced HCC. Conclusions. The pretreatment PNI and NLR levels have great prognostic implications for advanced HCC patients receiving TT. A higher PNI and a lower NLR suggest a higher postoperative survival rate.

Characteristics of cabozantinib treatment in advanced hepatocellular carcinoma

“…NLR, an indicator of systemic inflammation, is reportedly associated with poor outcomes in many malignancies, including HCC. 11 We previously reported that a high NLR is associated with poor outcomes in patients with HCC treated with lenvatinib, 12 and the same association was observed with cabozantinib.…”

“…Cox proportional analysis revealed that high albumin‐bilirubin score 10 and neutrophil–lymphocyte ratio (NLR) 11,12 were significant risk factors for survival in the univariate analysis (Table 4). We set the cut‐off at 4 based on findings from our previous study 11 .…”

“…Cox proportional analysis revealed that high albumin‐bilirubin score 10 and neutrophil–lymphocyte ratio (NLR) 11,12 were significant risk factors for survival in the univariate analysis (Table 4). We set the cut‐off at 4 based on findings from our previous study 11 . The survival curves were significantly better in patients with high NLR (>4) than in those with low NLR (Figure 2).…”

“…We set the cut-off at 4 based on findings from our previous study. 11 The survival curves were significantly better in patients with high NLR (>4) than in those with low NLR (Figure 2). The median survival time of the patients with high NLR (>4) and low NLR (≤4) were 2. other MTAs.…”

Blood-based biomarkers for immune-based therapy in advanced HCC: Promising but a long way to go

“…The prognostic nutritional index (PNI) is an immune-nutritional indicator and is calculated from the serum albumin (ALB) level and the peripheral blood and lymphocyte (LYM) count ( 77 ). A recent study defined the inflammation‐immunity‐nutrition score (IINS), which was simply based on highly sensitive C-reactive protein (hsCRP), LYM, and ALB ( 50 ).…”