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

Abstract

Shao-Ming Wei,1,&ast; Zhen-Xin Zeng,1,&ast; Rong-Jian Pan,1,&ast; 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 Yan1 1Shengli Clinical Medical College of Fujian Medical University, Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian Province, People’s Republic of China; 2Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, People’s Republic of China; 3Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Xiamen, Fujian Province, People’s Republic of China; 4Department of Hepato-Biliary-Pancreatic and Vascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, People’s Republic of China; 5Department of Interventional Radiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Mao-Lin Yan, Shengli Clinical Medical College of Fujian Medical University, Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Dongjie Road 134, Fuzhou, Fujian Province, 350001, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected]: 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

Keywords

• hepatocellular carcinoma
• immunity
• inflammation
• nutrition
• prognosis
• tumor response