Role of the Prognostic Nutritional Index in Predicting Survival in Advanced Hepatocellular Carcinoma Treated with Atezolizumab Plus Bevacizumab

Abstract

Introduction: The prognostic nutritional index (PNI) is a multiparametric score introduced by Onodera based on the blood levels of lymphocytes and albumin in patients with gastrointestinal neoplasms. Regarding hepatocellular carcinoma (HCC), its prognostic role has been demonstrated in patients treated with sorafenib and lenvatinib. The aim of this real-world study is to investigate the association between clinical outcomes and PNI in patients being treated with atezolizumab plus bevacizumab. Methods: The overall cohort of this multicentric study included 871 consecutive HCC patients from 4 countries treated with atezolizumab plus bevacizumab in first-line therapy. The PNI was calculated as follows: 10 × serum albumin concentration (g/dL) + 0.005 × peripheral lymphocyte count (number/mm3). Results: For only 773 patients, data regarding lymphocyte counts and albumin levels were available, so only these patients were included in the final analysis. The cut-off point of the PNI was determined to be 41 by receiver operating characteristic (ROC) analysis. 268 patients (34.7%) were categorized as the PNI-low group, while the remaining 505 (65.3%) patients as the PNI-high group. At the univariate analysis, high PNI was associated with longer overall survival (OS) (22.5 vs. 10.1 months, HR 0.34, p < 0.01) and progression-free survival (PFS) (8.7 vs. 5.8 months, HR 0.63, p < 0.01) compared to patients with low PNI. At the multivariate analysis, high versus low PNI resulted as an independent prognostic factor for OS (HR 0.49 , p < 0.01) and PFS (HR 0.82, p = 0.01). There was no difference in objective response rate (ORR) between the two groups (high 26.1% vs. low 19.8%, p = 0.09), while disease control rate (DCR) was significantly higher in the PNI-high group (76.8% vs. 66.4%, p = 0.01). Conclusion: PNI is an independent prognostic factor for OS and PFS in HCC patients on first-line treatment with atezolizumab plus bevacizumab.

Serum CXCL10 levels at the start of the second course of atezolizumab plus bevacizumab therapy predict therapeutic efficacy in patients with advanced BCLC stage C hepatocellular carcinoma: A multicenter analysis

“…To identify the factors influencing PFS and OS, we conducted univariate and multivariate analyses. Cutoffs for parameters other than serum CXCL10 levels were reported previously 24 . Univariate analysis revealed that only serum CXCL10‐2c levels were significantly associated with PFS (≥690 pg/mL vs. <690 pg/mL, hazard ratio [HR] = 0.39 p = 0.017; Table S5).…”

Systemic therapies in hepatocellular carcinoma: A revolution?

“…However, it is noteworthy that 58% of patients in the training set and 67% in the validation set received check-point inhibitors as monotherapy, which is not the current standard of care for the majority of patients. Persano et al 25 explored the significance of the Prognostic Nutritional Index (PNI), which takes into account lymphocyte counts and albumin level, while Chon et al 24 the role of baseline des-gamma-Carboxy prothrombin (DCP), and the neutrophil-to-lymphocyte ratio (NLR) as a potential predictors of OS, response and progression-free survival; respectively. Although Persano et al 25 examined 773 patients treated with atezolizumab plus bevacizumab, it is important to note that baseline characteristics such as liver function, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), and AFP levels were significantly different between patients classified as PNI-low and PNI-high groups.…”

“…Persano et al 25 explored the significance of the Prognostic Nutritional Index (PNI), which takes into account lymphocyte counts and albumin level, while Chon et al 24 the role of baseline des-gamma-Carboxy prothrombin (DCP), and the neutrophil-to-lymphocyte ratio (NLR) as a potential predictors of OS, response and progression-free survival; respectively. Although Persano et al 25 examined 773 patients treated with atezolizumab plus bevacizumab, it is important to note that baseline characteristics such as liver function, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), and AFP levels were significantly different between patients classified as PNI-low and PNI-high groups. On the other hand, Chon et al 26 used the median of DCP and NLR to group patients, but they did not analyze if patients were significantly different at baseline.…”

“…Persano et al. 25 explored the significance of the Prognostic Nutritional Index (PNI), which takes into account lymphocyte counts and albumin level, while Chon et al. 24 the role of baseline des‐gamma‐Carboxy prothrombin (DCP), and the neutrophil‐to‐lymphocyte ratio (NLR) as a potential predictors of OS, response and progression‐free survival; respectively.…”

“…Although Persano et al. 25 examined 773 patients treated with atezolizumab plus bevacizumab, it is important to note that baseline characteristics such as liver function, Eastern Cooperative Oncology Group Performance Status (ECOG‐PS), and AFP levels were significantly different between patients classified as PNI‐low and PNI‐high groups. On the other hand, Chon et al.…”