Pretreatment Prognostic Nutritional Index Predicts Progression-Free Survival in BCLC Stage C Hepatocellular Carcinoma Treated with Sorafenib
Cancer Management and Research, vol.18, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 18
- Publication Date: 2026
- Doi Number: 10.2147/cmar.s621105
- Journal Name: Cancer Management and Research
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, Directory of Open Access Journals, Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Keywords: ALBI, BCLC stage C, Hepatocellular carcinoma, mGPS, NLR, PI, PLR, PNI, prognosis, progression-free survival, SII, sorafenib
- Eskisehir Osmangazi University Affiliated: Yes
Abstract
Background: Systemic inflammation and nutritional status are key determinants of tumor progression in advanced hepatocellular carcinoma (HCC). This study aimed to evaluate the prognostic significance of inflammation and nutrition based indices in patients with BCLC stage C HCC treated with sorafenib. Methods: This retrospective cohort study included 109 patients with Barcelona Clinic Liver Cancer (BCLC) stage C HCC who received sorafenib as first line systemic therapy. A complete-case approach was used for multivariate Cox regression analysis. Progression-free survival (PFS) was defined according to RECIST version 1.1. Kaplan–Meier survival analysis and Cox proportional hazards regression models were used to assess prognostic factors. Results: In Kaplan–Meier and univariate Cox analyses, several inflammation- and nutrition-based indices, including NLR, PLR, SII, mGPS, PI, and ALBI grade, were significantly associated with PFS. Although the total cohort included 109 patients, the final multivariate Cox regression model for PNI included 78 complete-case patients. In this model, low prognostic nutritional index (PNI) (HR: 2.36, 95% CI: 1.14–4.87, p=0.020) and prior local ablative treatment (HR: 0.45, 95% CI: 0.24–0.83, p=0.011) remained independently associated with PFS. Conclusion: Pretreatment low PNI was independently associated with shorter progression-free survival in patients with BCLC stage C HCC treated with sorafenib. Other inflammation and nutrition-based indices were associated with PFS in univariate analyses but did not retain independent prognostic significance after adjustment. PNI may serve as a simple prognostic marker for risk stratification in real-world settings, although external validation is required.