The role of the prognostic nutritional index as a prognostic factor in patients with hepatocellular carcinoma.

Introduction and Objectives

Immune-nutritional status has been demonstrated to be associated with prognosis in patients with various malignancies. The aim of this study is to determine the association of the nutritional prognostic index (PNI) with survival and assess the correlation between PNI and clinic-pathological parameters in HCC patients.

Materials and Patients

An observational, retrospective, descriptive and case series study was performed. We included 69 patients from a third-level hospital with a diagnosis of HCC from February 01, 2019 to July 24, 2023 and studied their survival 12 months after diagnosis. We determined the association between PNI status and their clinic-pathological characteristics and evaluated the impact of PNI on the HCC patient survival. The following formula was used to determine PNI: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per µL). Clinic-pathological characteristics related to disease prognosis included age, sex, body mass index (BMI), alpha-fetoprotein (AFP) value, the presence or not of cirrhosis, tumor size, ECOG score, and BCLC grade. Qualitative data are expressed as percentages and quantitative data as mean±SD. Statistical comparison was performed with two-tailed unpaired Student's t-test or chi-square and Fisher's exact test. Statistical significance was defined as P<0.05.

Results

Of the 69 patients diagnosed with HCC, most of the studied population was found to involve males at 56.52% while females were reported at 43.48%, with an age range of 26-81 years and a median age of 61.84, 61.84±9.8 (59.53-64.15). Of the total sample, 10.14% were patients with no diagnosis of cirrhosis while 89.86% were patients with some degree of cirrhosis (Child Pugh Stages: A 37.68%, B 43.48%, C 8.70%). The results indicated that low PNI is associated with poor prognosis while high PNI was found to be beneficial for survival with a 95 % CI=35.48±8.41 (32.42-38.54), 95% CI=40.86±5.42 (39.19-42.54) p=0.0019, respectively. It is also associated with more favorable outcomes, such as lower AFP, lower ECOG grade and lower BCLC staging (p=0.0371, p=0.0303, p= 0.002), respectively. However, we found that age, sex, presence or absence of cirrhosis, BMI and tumor size were not statistically significantly associated with the PNI value.

Conclusions

PNI is an independent predictive indicator of survival and is significantly associated with serum AFP, ECOG score, and BCLC stage in patients with HCC.

Ethical statement: The research was carried out in accordance with the Helsinki Declaration of the World Assembly 2013.

Declaration of interests: None.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.