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. 2025 Jun 10:18:7545-7557.
doi: 10.2147/JIR.S520339. eCollection 2025.

Prognostic Value of the SII-PNI Score in Unresectable HCC Treated with Transcatheter Arterial Chemoembolization Combined with Lenvatinib and PD-1 Inhibitors

Shao-Ming Wei #  1 , Zhen-Xin Zeng #  1 , Rong-Jian Pan #  1 , Jia-Yi Wu  1 , Jun-Yi Wu  1 , Meng-Chao Luo  1 , Yi-Nan Li  1 , Han Li  1 , De-Yi Liu  1 , Xiang-Ye Ou  1 , Zhi-Bo Zhang  2 , Jian-Yin Zhou  3 , Bin Li  4 , Shao-Wu Zhuang  5 , Mao-Lin Yan  1
Affiliations

Prognostic Value of the SII-PNI Score in Unresectable HCC Treated with Transcatheter Arterial Chemoembolization Combined with Lenvatinib and PD-1 Inhibitors

Shao-Ming Wei et al. J Inflamm Res. .

Abstract

Purpose: The combined systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) (SII-PNI score) serves as a prognostic predictor in various malignancies. This study evaluates the prognostic value of the SII-PNI score in patients with unresectable hepatocellular carcinoma (uHCC) treated with transcatheter arterial chemoembolization combined with lenvatinib and PD-1 inhibitors (triple therapy).

Patients and methods: This retrospective multicenter study included patients with uHCC treated with triple therapy from eight hospitals. The optimal cut-off values for SII and PNI were determined using X-tile. The SII-PNI score was categorized as follows: score of 0, low SII (≤cut-off value) and high PNI (>cut-off value); score of 1, either high SII-high PNI or low SII-low PNI; score of 2, high SII and low PNI. Survival curves were estimated and compared using the Kaplan-Meier method with the Log rank test.

Results: A total of 290 patients were included. The optimal cut-off values were 525.9 for SII and 44.0 for PNI. Patients were classified as SII-PNI score of 0 (n = 105), score of 1 (n = 124), and score of 2 (n = 61). Lower SII-PNI score was associated with better median overall survival (score of 0: not reached vs score of 1: 28.0 months vs score of 2: 19.7 months; p < 0.001). Similarly, the median progression-free survival for SII-PNI scores of 0, 1, and 2 was 25.5, 16.6, and 12.9 months, respectively (p < 0.001). Lower SII-PNI score also indicated better objective response rate (p = 0.007) and disease control rate (p = 0.003). The SII-PNI score was identified as an independent predictor of overall survival and progression-free survival in multivariate COX regression analysis.

Conclusion: The SII-PNI score is associated with survival and tumor response in patients with uHCC treated with triple therapy. This score aids in optimizing clinical decision-making for uHCC.

Keywords: hepatocellular carcinoma; immunity; inflammation; nutrition; prognosis; tumor response.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Correlation analysis between the SII and PNI levels.
Figure 2
Figure 2
Kaplan–Meier curves according to the SII-PNI score. (A) Overall survival. (B) Progression-free survival.
See this image and copyright information in PMC

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