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      Role of the Prognostic Nutritional Index in Predicting Survival in Advanced Hepatocellular Carcinoma Treated with Atezolizumab Plus Bevacizumab

      research-article
      a , b , c , d , e , f , g , h , i , j , k , l , m , n , o , p , d , e , f , g , h , j , k , l , n , q , d , e , f , h , r , s , t , u , v , w , x , y , z , A , B , C , C , D , E , F , G , H , I , q , q , s , t , v , v , u , u , u , z , J , K , s , c , J , E , r , b , L , M , L , M , a , N , N , *
      Oncology
      S. Karger AG
      Advanced hepatocellular carcinoma, Atezolizumab plus bevacizumab, Prognostic factor, Immunotherapy, Nutrition

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          Abstract

          Introduction: The prognostic nutritional index (PNI) is a multiparametric score introduced by Onodera based on the blood levels of lymphocytes and albumin in patients with gastrointestinal neoplasms. Regarding hepatocellular carcinoma (HCC), its prognostic role has been shown in patients treated with sorafenib and lenvatinib. The aim of this real-world study was to investigate the association between clinical outcomes and PNI in patients being treated with atezolizumab plus bevacizumab. Methods: The overall cohort of this multicentric study included 871 consecutive HCC patients from 5 countries treated with atezolizumab plus bevacizumab in first-line therapy. The PNI was calculated as follows: 10 × serum albumin concentration (g/dL) + 0.005 × peripheral lymphocyte count (number/mm<sup>3</sup>). Results: Data regarding lymphocyte counts and albumin levels were available for 773 patients; therefore, these patients were included in the final analysis. The cut-off point of the PNI was determined to be 41 by receiver operating characteristic analysis. 268 patients (34.7%) were categorized as the PNI-low group, while the remaining 505 (65.3%) patients as the PNI-high group. At the univariate analysis, high PNI was associated with longer overall survival (OS) (22.5 vs. 10.1 months, HR 0.34, p <0.01) and progression-free survival (PFS) (8.7 vs. 5.8 months, HR 0.63, p <0.01) compared to patients with low PNI. At the multivariate analysis, high versus low PNI resulted as an independent prognostic factor for OS (HR 0.49, p <0.01) and PFS (HR 0.82, p = 0.01). There was no difference in objective response rate between the two groups (high 26.1% vs. low 19.8%, p = 0.09), while disease control rate was significantly higher in the PNI-high group (76.8% vs. 66.4%, p = 0.01). Conclusion: PNI is an independent prognostic factor for OS and PFS in HCC patients on first-line treatment with atezolizumab plus bevacizumab.

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          Author and article information

          Journal
          OCL
          Oncology
          10.1159/issn.0030-2414
          Oncology
          Oncology
          S. Karger AG
          0030-2414
          1423-0232
          2023
          May 2023
          19 January 2023
          : 101
          : 5
          : 283-291
          Affiliations
          [_a] aMedical Oncology, University and University Hospital of Cagliari, Cagliari, Italy
          [_A] ADepartment of Gastroenterology, Toyama University Hospital, Toyama, Japan
          [_b] bDepartment of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
          [_B] BHepato-biliary Center, Japanese Red Cross Matsuyama Hospital, Matsuyama, Japan
          [_c] cDepartment of Internal Medicine, Japanese Red Cross Himeji Hospital, Himeji, Japan
          [_C] CDepartment of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
          [_d] dDepartment of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
          [_D] DDepartment of Gastroenterology, Japanese Red Cross Takamatsu Hospital, Takamatsu, Japan
          [_e] eDivision of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
          [_E] EDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Japan
          [_f] fDepartment of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Higashi-osaka, Japan
          [_F] FDepartment of Gastroenterology, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan
          [_g] gDepartment of Medical Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
          [_G] GDepartment of Clinical Research, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
          [_h] hDepartment of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
          [_H] HDivision of Gastroenterology and Hepatology, Otakanomori Hospital, Kashiwa, Japan
          [_i] iDepartment of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
          [_I] IDepartment of Hepatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
          [_j] jLiver Unit-CHTMAD, Vila Real, Portugal
          [_J] JDepartment of Surgery, Kansai Medical University, Osaka, Japan
          [_k] kUnit of Medical Oncology 2, University Hospital of Pisa, Pisa, Italy
          [_K] KDepartment of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
          [_l] lDepartment of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
          [_L] LSchool of Medicine, Vita-Salute San Raffaele University, Milan, Italy
          [_m] mDepartment of Oncology, ASAN Medical Center, University of Ulsan College of Medicine, Korea, Seoul, Republic of Korea
          [_M] MHepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Liver Center, Vita-Salute San Raffaele University, Milan, Italy
          [_n] nOncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
          [_N] NDepartment of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
          [_o] oDivision of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, University of Bologna, Bologna, Italy
          [_p] pDepartment of Nursing, Gifu Kyoritsu University, Ogaki, Japan
          [_q] qGastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
          [_r] rDepartment of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan
          [_s] sDepartment of Gastroenterology, Okayama City Hospital, Okayama, Japan
          [_t] tDepartment of Gastroenterology and Hepatology, Kagawa University, Takamatsu, Japan
          [_u] uDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
          [_v] vDepartment of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
          [_w] wDepartment of Gastroenterology, Asahi General Hospital, Asahi, Japan
          [_x] xDepartment of Gastroenterology, Osaka Medical and Pharmaceutical University, Osaka, Japan
          [_y] yCenter of Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
          [_z] zDepartment of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
          Author notes
          *Margherita Rimini, margherita.rimini@gmail.com
          Author information
          https://orcid.org/0000-0002-0976-6761
          https://orcid.org/0000-0002-4102-3474
          https://orcid.org/0000-0001-8559-9910
          https://orcid.org/0000-0001-8329-8989
          https://orcid.org/0000-0002-1451-8455
          https://orcid.org/0000-0003-2211-495X
          https://orcid.org/0000-0003-0061-059X
          https://orcid.org/0000-0002-6979-5812
          https://orcid.org/0000-0001-9307-2326
          https://orcid.org/0000-0002-2914-6674
          https://orcid.org/0000-0003-1989-0480
          https://orcid.org/0000-0001-7943-3842
          https://orcid.org/0000-0002-9111-5668
          https://orcid.org/0000-0003-3996-7502
          https://orcid.org/0000-0002-5470-9694
          https://orcid.org/0000-0002-2373-8601
          https://orcid.org/0000-0002-1652-6168
          https://orcid.org/0000-0002-5517-8303
          https://orcid.org/0000-0003-3656-285X
          https://orcid.org/0000-0003-0224-7093
          https://orcid.org/0000-0002-4986-8578
          https://orcid.org/0000-0002-1882-824X
          https://orcid.org/0000-0002-2018-0008
          https://orcid.org/0000-0002-0760-3045
          https://orcid.org/0000-0003-1244-4736
          https://orcid.org/0000-0001-6448-6036
          https://orcid.org/0000-0002-2926-9973
          https://orcid.org/0000-0003-0663-0102
          https://orcid.org/0000-0002-0577-3921
          https://orcid.org/0000-0003-4117-339X
          https://orcid.org/0000-0002-0146-4136
          https://orcid.org/0000-0001-6289-7202
          Article
          528818 Oncology 2023;101:283–291
          10.1159/000528818
          36657420
          c629d5cd-045d-438e-b2cf-839774ae99b6
          © 2023 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.

          History
          : 11 September 2022
          : 01 December 2022
          Page count
          Figures: 2, Tables: 3, Pages: 9
          Funding
          The present work received no financial support.
          Categories
          Clinical Study

          Medicine
          Advanced hepatocellular carcinoma,Nutrition,Immunotherapy,Prognostic factor,Atezolizumab plus bevacizumab

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