Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan,
Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
Oncology. 2020;98(5):295-302. doi: 10.1159/000506293. Epub 2020 Feb 25.
BACKGROUND/AIM: Few studies have examined the details of nutritional status in patients with unresectable hepatocellular carcinoma (u-HCC) undergoing systemic chemotherapy with lenvatinib. We evaluated the prognostic/predictive value of nutritional status using Onodera's prognostic nutritional index (O-PNI) for overall survival among patients with u-HCC treated with lenvatinib.
Three-hundred and seventy-five u-HCC patients treated with lenvatinib were enrolled (median age 72 years; Child-Pugh class A/B/C: n = 312/60/3; BCLC stage A/B/C/D: n = 2/159/212/2). We examined median survival time (MST) and time to progression (TTP) in all patients (n = 375), prognosis according to the O-PNI (high/low: >40/≤40) in 298 patients with lymphocyte findings, and the prognostic/predictive values of Child-Pugh stage, albumin-bilirubin (ALBI)/modified ALBI (mALBI) grade, and O-PNI for Chemotherapy grade (OPNIC grade 1/2/3: O-PNI >40/≤40 to >36/≤36).
The MST and TTP were 16.6 and 8.0 months, respectively. The MST and TTP according to the O-PNI (>40/≤40) were "not reached" (NR)/12.4 months (p < 0.001) and 10.0/6.1 months (p = 0.012), respectively. There was a good correlation noted between ALBI score and O-PNI (r = -0.939, p < 0.001). The predictive value of the O-PNI for mALBI grade 2a was 36.0 (specificity/sensitivity = 0.894/0.942; area under the curve [AUC] = 0.978), while that for mALBI grade 1 was 39 (specificity/sensitivity = 0.920/0.929; AUC = 0.972), which was very similar to a high O-PNI. The MST analyzed with the OPNIC in the 298 patients was NR/16.2/10.4 months for OPNIC grade 1/2/3 (p < 0.001), respectively, and the c-index was 0.632, the same as that for mALBI grade (0.632), while that for Child-Pugh class was 0.571.
OPNIC grading might have a potential for easy substitution of mALBI grading. A good nutritional status (OPNIC grade 1) or mALBI grade 1 is the best indication for lenvatinib use, while with an OPNIC grade 3, lenvatinib might be not suitable.
背景/目的：很少有研究探讨接受仑伐替尼全身化疗的不可切除肝细胞癌（u-HCC）患者的营养状况细节。我们使用小野预后营养指数（O-PNI）评估了营养状况对接受仑伐替尼治疗的 u-HCC 患者总生存期的预后/预测价值。
共纳入 375 例接受仑伐替尼治疗的 u-HCC 患者（中位年龄 72 岁；Child-Pugh 分级 A/B/C：n=312/60/3；BCLC 分期 A/B/C/D：n=2/159/212/2）。我们检查了所有患者（n=375）的中位生存时间（MST）和无进展时间（TTP），298 例有淋巴细胞检查结果的患者根据 O-PNI（高/低：>40/≤40）的预后，以及 Child-Pugh 分级、白蛋白-胆红素（ALBI）/改良 ALBI（mALBI）分级和 O-PNI 对化疗分级（OPNIC 分级 1/2/3：O-PNI>40/≤40 至>36/≤36）的预后/预测价值。
MST 和 TTP 分别为 16.6 和 8.0 个月。根据 O-PNI（>40/≤40）的 MST 和 TTP 为“未达到”（NR）/12.4 个月（p<0.001）和 10.0/6.1 个月（p=0.012）。ALBI 评分与 O-PNI 之间存在很好的相关性（r=-0.939，p<0.001）。O-PNI 对 mALBI 分级 2a 的预测值为 36.0（特异性/灵敏度=0.894/0.942；曲线下面积[AUC]=0.978），而对 mALBI 分级 1 的预测值为 39（特异性/灵敏度=0.920/0.929；AUC=0.972），与高 O-PNI 非常相似。在 298 例患者中，使用 OPNIC 分析的 MST 为 OPNIC 分级 1/2/3 的 NR/16.2/10.4 个月（p<0.001），C 指数为 0.632，与 mALBI 分级相同（0.632），而 Child-Pugh 分级为 0.571。
OPNIC 分级可能具有替代 mALBI 分级的潜力。良好的营养状况（OPNIC 分级 1）或 mALBI 分级 1 是仑伐替尼使用的最佳指征，而 OPNIC 分级 3 则不适合仑伐替尼治疗。
