Abstract
OBJECTIVE: To explore the relationship between the prognostic nutritional index (PNI) and the anti-tumor efficacy and prognosis of patients with advanced hepatocellular carcinoma (HCC) who received first-line therapy. METHODS: A total of 234 patients with advanced HCC were included in this study, all of whom received first-line therapy. The clinical and pathological data of patients were collected. Patients were divided into high PNI group and low PNI group according to the median value of PNI. Kaplan-Meier method was used to describe the curves of overall survival (OS) and progression-free survival (PFS), and the multivariate Cox analyses were performed to identify the independent risk factors for OS and PFS. RESULTS: The median PNI of all patients was 46.2, and all patients were divided into low PNI group (n = 117) and high PNI group (n = 117). Multivariate Cox analysis showed that PNI (hazard ratio (HR): 0.584, 95 confidence interval (CI): 0.426-0.802; HR: 0.630, 95%CI: 0.482-0.825) was a prognostic factor of OS and PFS, and the prognosis of patients with high PNI was better than that of patients with low PNI. Subgroup analysis showed the similar results for patients receiving lenvatinib or atezolizumab plus bevacizumab (T + A). The overall response rate (ORR) of patients with high PNI was higher than that of patients with low PNI (P = 0.005). There was no statistical difference in the incidence of adverse reactions between the two groups. CONCLUSION: High PNI is a prognostic factor affecting OS and PFS for patients with advanced HCC who received first-line therapy. Patients with high PNI have higher ORR and better prognosis. There was no significant difference in the incidence of adverse reactions among patients with high or low PNI.