Pretreatment PNI, NLR predict survival in early stage hepatocellular carcinoma
Pretreatment prognostic nutritional index (PNI) and neutrophil-to-lymphocyte ratio (NLR) predict survival in patients with early stage hepatocellular carcinoma (HCC) undergoing radiofrequency ablation (RFA), reports a recent study.
The study included 118 newly-diagnosed HCC patients (mean age 69.4±10.4 years; 63 percent male) undergoing RFA. Over a median follow-up of 36 months, 14 percent (n=17) died due to HCC progression, 10 percent (n=12) due to liver failure and 13 percent (n=15) due to reasons unrelated to liver failure.
The resulting overall survival (OS) rates at years 1, 3 and 5 after RFA were 90 percent, 67 percent and 52 percent, respectively.
Survival analyses showed that inflammation-based indices strongly predicted OS. For instance, participants with high NLR had shorter median OS durations than those with low NLR (cutoff, 2.5; 33 vs 38.1 months). In contrast, those with high vs low PNI had longer median OS (cutoff, 40; 38.2 vs 33.2 months).
Moreover, those with combined low NLR and high PNI had the most favourable outcomes (median OS, 38.6 months). Platelet-to-lymphocyte ratio was not a prognostic factor for survival in HCC patients after RFA.
These were confirmed in multivariate Cox proportional hazards analysis, which showed that high NLR (hazard ratio [HR], 1.94; 95 percent CI, 1.05–3.59; p=0.034) and low PNI (HR, 0.38; 0.20–0.72; p=0.003) were significant and independent factors for OS.
Other such factors were a history of end-stage renal disease (HR, 3.60; 1.48–8.76; p=0.005) and elevated α-foetoprotein levels (≥200 ng/mL; HR, 4.61; 1.75–12.13; p=0.002).