Prognostic value of nutritional index before sorafenib treatment in advanced stage hepatocellular cancer patients

Introduction and Aim: The primary aim of this study was to investigate the relationship between Prognostic Nutritional Index (PNI) levels and survival outcomes in patients diagnosed with hepatocellular carcinoma (HCC). The study sought to evaluate the potential role of PNI as a predictive marker for disease progression and prognosis in HCC patients. Materials and Methods: This retrospective descriptive study was conducted on patients diagnosed with hepatocellular carcinoma and planned for sorafenib treatment at Tokat Gaziosmanpaşa University Oncology Clinic between January 1, 2013, and April 1, 2024. Demographic, clinical, and laboratory data of the patients were obtained through the hospital information system. Groups formed based on prognostic nutritional index levels were compared for survival. Data analysis was performed using SPSS 22.0, and appropriate statistical tests were applied. A p-value of <0.05 was considered the level of significance. Results: A total of 48 patients aged over 18 years with hepatocellular carcinoma were included in the study. The majority of patients were male (87.5%), with a median age of 66.5 years. Hepatitis B infection was identified as the most common etiological factor (68.8%). At the time of diagnosis, 58.3% of patients had a tumor size larger than 5 cm, and 70.8% had three or more lesions. The most frequently applied treatment modality was transarterial chemoembolization (TACE, 29.2%), followed by surgical resection (22.9%), radiofrequency ablation (8.3%), and TARE (6.3%). ROC curve analysis identified the optimal PNI cutoff value as 43.2 (AUC=0.833; p<0.001). Patients were subsequently classified into high- and low-PNI groups according to this threshold. The low-PNI group exhibited significantly lower serum albumin and lymphocyte levels, and higher total bilirubin levels. Kaplan–Meier survival analysis demonstrated that the median overall survival was 25 months in the high-PNI group and 9.4 months in the low-PNI group (p=0.011). Median progression-free survival was 15.3 months and 2.8 months, respectively (p<0.001). The disease control rate was 79.2% in the high-PNI group and 25.0% in the low-PNI group (p<0.001), indicating that higher PNI levels were associated with improved survival and treatment response. Conclusion: Our study demonstrated that the Prognostic Nutritional Index (PNI) serves as an independent and significant prognostic biomarker in patients with hepatocellular carcinoma. Patients with higher PNI levels had a median overall survival of 25.0 months, compared to 9.4 months in the low-PNI group. Similarly, progression-free survival was significantly longer in the high-PNI group (15.3 vs. 2.8 months; p<0.001). As PNI is based solely on serum albumin concentration and lymphocyte count, it represents a simple, cost-effective, and easily obtainable index suitable for clinical application. Low PNI values reflect poor nutritional status and impaired immune function, correlating with worse prognosis. These findings support the use of PNI as a reliable, practical, and clinically applicable prognostic indicator in patients with hepatocellular carcinoma. Keywords: Hepatocellular carcinoma, Prognostic Nutritional Index, Survival