Prognostic nutritional index is superior as a predictor of prognosis among various inflammation-based prognostic scores in patients with hepatocellular carcinoma after curative resection

Daisuke Imai; Takashi Maeda; Mototsugu Shimokawa; Huanlin Wang; Shohei Yoshiya; Kazuki Takeishi; Shinji Itoh; Noboru Harada; Toru Ikegami; Tomoharu Yoshizumi; Masaki Mori

doi:10.1111/hepr.13431

Prognostic nutritional index is superior as a predictor of prognosis among various inflammation-based prognostic scores in patients with hepatocellular carcinoma after curative resection

Hepatol Res. 2020 Jan;50(1):101-109. doi: 10.1111/hepr.13431. Epub 2019 Nov 14.

Authors

Affiliations

¹ Department of Surgery, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Hiroshima, Japan.
² Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
³ Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.

PMID: 31692173
DOI: 10.1111/hepr.13431

Abstract

Aim: There is increasing evidence that inflammation-based prognostic scores are stage-independent predictors of poor outcome in patients with hepatocellular carcinoma (HCC). However, these findings were observed in a small-sized study comparing the prognostic value of these scores for patients after curative resection for HCC.

Methods: We retrospectively analyzed 717 consecutive patients with HCC who underwent curative liver resection at Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital. Clinicopathological variables including preoperative inflammation-based prognostic scores, such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, Controlling Nutritional Status score, prognostic nutritional index (PNI), and Glasgow Prognostic Score were analyzed. The prognostic value of these scores was compared by the time-dependent receiver operating characteristic curve analyses.

Results: The integrate area under the curve of PNI, Controlling Nutritional Status score, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and Glasgow Prognostic Score were 0.6751, 0.6435, 0.5845, 0.5276, and 0.5351 for overall survival (OS), respectively, and 0.5955, 0.5694, 0.4692, 0.4873, and 0.5272 for disease-free survival, respectively. Multivariate analyses for prognosis factor in HCC patients showed that PNI was an independent predictor of both OS (HR 0.91, P < 0.001) and disease-free survival (HR 0.94, P < 0.001). When the patients were divided into high and low PNI groups, the patients in the low PNI group had significant poorer OS (P < 0.001) and disease-free survival (P < 0.001), even after background factors were matched between these two groups.

Conclusions: PNI is superior to Controlling Nutritional Status score, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, or Glasgow Prognostic Score as a predictor of OS and recurrence-free survival in patients with HCC who underwent curative hepatic resection.

Keywords: controlling nutritional status; hepatocellular carcinoma; neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio; prognostic nutritional index.