The prognostic nutritional index (PNI), which is determined by measuring serum albumin and lymphocyte count, has been suggested as a way to assess immune-nutritional status in patients with hepatocellular carcinoma (HCC). Researchers have investigated whether PNI can predict outcomes in patients with advanced HCC who are treated with the combination therapy of atezolizumab and bevacizumab.
In this study, data from 362 patients with unresectable HCC who received atezolizumab plus bevacizumab between November 2020 and June 2023 at two centers were retrospectively analyzed. Patients were divided into two groups based on a PNI cutoff value of 45: those with low PNI (<45) and those with high PNI (≥45). To reduce bias, propensity score matching was used to balance baseline characteristics between the groups.
After matching, the analysis included 130 patients—65 in each group. The findings showed that patients in the high-PNI group experienced fewer severe treatment-related adverse events (10.8% compared to 24.6%), had a higher objective response rate (38.4% compared to 20.0%), and lived longer overall (16.7 months versus 7.9 months). The difference in progression-free survival between groups was not statistically significant.
According to multivariate analysis, “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.”
The authors concluded: “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.”
