Role of the prognostic nutritional index in predicting survival in advanced hepatocellular carcinoma treated with regorafenib

Background It has been demonstrated the link between malnutrition, immunological status and Hepatocarcinoma (HCC). The Prognostic Nutritional Index (PNI) has been recognized as prognostic indicator in early-stage HCC and in patients treated with first line therapy. Nowadays, no data report the role of the PNI in HCC patients treated with regorafenib. Matherials and methods We performed a multicentric analysis on a cohort of 284 patients affected by advanced HCC treated with regorafenib. The PNI was calculated as follows: 10 × serum albumin concentration (g/dL) + 0.005 × peripheral lymphocyte count (number/mm 3 ). Univariate and multivariate analysis were performed to investigate the association between PNI and survival outcomes. Results A PNI cut-off value of 44.45 was calculated by performing a ROC analysis. The median overall survival (mOS) was 12.8 months and 7.8 months for patients with high (>44.45) and low (≤ 44.45) PNI, respectively (HR 0.58; 95% CI 0.43-0.77; p=0.0002). At the uni- and multivariate analysis, low PNI value and increased serum bilirubin level emerged as independent prognostic factors for OS. No differences have been found between high versus low PNI in terms of progression free survival (PFS) (p=0.14). Conclusion If validated, the PNI could represent an easy-to-use prognostic tool able to guide the clinical decision-making process in HCC patients treated with regorafenib. This article is protected by copyright. All rights reserved.