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. 2025 Apr 3;25(1):603.
doi: 10.1186/s12885-025-13993-5.

Prognostic nutritional index predicts survival in intermediate and advanced hepatocellular carcinoma treated with hepatic arterial infusion chemotherapy combined with PD-(L)1 inhibitors and molecular targeted therapies

Hao-Huan Tang #  1 , Ming-Qing Zhang #  2 , Zi-Chen Zhang #  3 , Chen Fan  1 , Shu-Shu Li  4 , Wei Chen  5 , Wei-Dong Wang  6
Affiliations

Prognostic nutritional index predicts survival in intermediate and advanced hepatocellular carcinoma treated with hepatic arterial infusion chemotherapy combined with PD-(L)1 inhibitors and molecular targeted therapies

Hao-Huan Tang et al. BMC Cancer. .

Abstract

Background: This study aimed to evaluate the predictive efficacy of the prognostic nutritional index (PNI) in patients with intermediate and advanced hepatocellular carcinoma (HCC) treated with a regimen consisting of hepatic arterial infusion chemotherapy (HAIC), PD-(L)1 inhibitors, and molecular targeted therapies (MTTs).

Methods: A retrospective analysis was performed on the data of 88 HCC patients received triple therapy between January 2020 and August 2022 at three medical centers. Univariate and multivariable analyses were conducted to assess the relationship between PNI and survival outcomes.

Results: The median follow-up was 11.0 months (IQR: 8.0-17.0). The PNI cut-off value of 38.6 was determined using receiver operating characteristics (ROC) analysis. The median overall survival (OS) durations were 29.0 and 8.0 months in the high-PNI (≥ 38.6) and low-PNI (≤ 38.6) groups, respectively (HR = 0.306, 95% CI, 0.170-0.552, P < 0.001), and the median progression-free survival (PFS) durations were16.0 and 6.0 months, respectively (HR = 0.521, 95% CI, 0.303-0.896, P = 0.014). A higher complete response rate was observed in the high-PNI group (17.5% vs. 3.2%, P = 0.033). The univariate and multivariable analyses revealed that a PNI of ≥ 38.6 had an independent influence on both median OS (HR = 0.296; 95% CI, 0.159-0.551, P < 0.001) and median PFS (HR = 0.560; 95% CI, 0.318-0.987, P = 0.045).

Conclusion: The PNI is an objective and convenient tool that can potentially predict the prognosis of patients treated with HAIC-based triple therapy.

Keywords: Hepatic arterial infusion chemotherapy; Hepatocellular carcinoma; Immunotherapy; Molecular targeted therapies; Prognostic nutritional index.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Ethics Committee of Wuxi People’s Hospital, affiliated with Nanjing Medical University, approved this study (No. KY23101) and conducted it in accordance with the tenets of the Declaration of Helsinki. Given the retrospective nature of the study, the Ethics Committee granted an exemption for written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The study’s flow diagram
Fig. 2
Fig. 2
The cutoff value (A) and the ROC curve (B) of PNI. Panel A displays the distribution of PNI values (upper graph) and the maximally selected rank statistics (lower graph) to determine the optimal cut-point of PNI, which was identified as 38.6. Different colors represent different groups. Panel B shows the ROC curve of PNI, with an area under the curve of 0.704 (95% CI: 0.592–0.815). ROC, receiver operating characteristic; PNI, prognostic nutritional index
Fig. 3
Fig. 3
Kaplan-Meier curves for OS (A) and PFS (B) in 88 patients treated with HAIC triple therapy. (A) OS according to PNI (high- vs. low-group). (B) PFS accord ing to PNI (high- vs. low-group). OS, overall survival; PFS, progression-free survival; HAIC, hepatic arterial infusion chemotherapy; PNI, prognostic nutritional index
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