营养状况与接受阿替利珠单抗联合贝伐单抗治疗的晚期不可切除肝细胞癌患者的预后相关。
Nutritional Status Is Associated with Prognosis in Patients with Advanced Unresectable Hepatocellular Carcinoma Treated with Atezolizumab plus Bevacizumab.
作者信息
Tada Toshifumi, Kumada Takashi, Hiraoka Atsushi, Kariyama Kazuya, Tani Joji, Hirooka Masashi, Takaguchi Koichi, Atsukawa Masanori, Fukunishi Shinya, Itobayashi Ei, Tsuji Kunihiko, Tajiri Kazuto, Ochi Hironori, Ishikawa Toru, Yasuda Satoshi, Ogawa Chikara, Toyoda Hidenori, Hatanaka Takeshi, Nishimura Takashi, Kakizaki Satoru, Kawata Kazuhito, Shimada Noritomo, Tada Fujimasa, Nouso Kazuhiro, Tsutsui Akemi, Ohama Hideko, Morishita Asahiro, Nagano Takuya, Itokawa Norio, Okubo Tomomi, Arai Taeang, Kosaka Hisashi, Imai Michitaka, Naganuma Atsushi, Nakamura Shinichiro, Koizumi Yohei, Matono Tomomitsu, Kaibori Masaki, Iijima Hiroko, Hiasa Yoichi
机构信息
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Japan.
Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Himeji, Japan.
出版信息
Oncology. 2023;101(4):270-282. doi: 10.1159/000527676. Epub 2022 Dec 1.
INTRODUCTION
This study investigated the relationship between nutritional status, as determined by the prognostic nutritional index (PNI), and outcomes in patients with unresectable hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab (Atez/bev).
METHODS
The study analyzed 485 HCC patients treated with Atez/bev.
RESULTS
There were 342 patients with a low PNI (<47) and 143 patients with a high PNI (≥47). The median follow-up duration was 9.4 (6.0-14.3) months. Multivariate Cox hazards analysis showed that an α-fetoprotein level ≥100 ng/mL (hazard ratio (HR), 2.217; 95% confidence interval (CI), 1.588-3.095; p < 0.001), and PNI ≥47 (HR, 0.333; 95% CI, 0.212-0.525; p < 0.001) were independently associated with overall survival. Multivariate analysis showed that an α-fetoprotein level ≥100 ng/mL (HR, 1.690; 95% CI, 1.316-2.170; p < 0.001) and PNI ≥47 (HR, 0.696; 95% CI, 0.528-0.918; p = 0.010) were independently associated with progression-free survival. Cumulative overall and progression-free survival rates differed significantly by PNI (p < 0.001 and p < 0.002, respectively). In a subgroup analysis using inverse probability weighting adjustment in patients with albumin-bilirubin grade 1 (n = 173), univariate Cox hazards analysis showed that a PNI ≥47 (HR, 0.502; 95% CI, 0.260-0.991; p = 0.047) was significantly associated with overall survival. Spline curve analysis revealed that a PNI of approximately 34-48 is an appropriate cutoff for predicting good overall and progression-free survival.
CONCLUSION
The PNI, a biomarker of nutritional status, can predict prognosis in patients with HCC treated with Atez/bev, even those who are considered to have a good prognosis due to good liver function.
引言
本研究调查了由预后营养指数（PNI）确定的营养状况与接受阿替利珠单抗联合贝伐珠单抗（阿替利珠单抗/贝伐珠单抗）治疗的不可切除肝细胞癌（HCC）患者预后之间的关系。
方法
该研究分析了485例接受阿替利珠单抗/贝伐珠单抗治疗的HCC患者。
结果
PNI低（<47）的患者有342例，PNI高（≥47）的患者有143例。中位随访时间为9.4（6.0 - 14.3）个月。多变量Cox风险分析显示，甲胎蛋白水平≥100 ng/mL（风险比（HR），2.217；95%置信区间（CI），1.588 - 3.095；p < 0.001）和PNI≥47（HR，0.333；95% CI，0.212 - 0.525；p < 0.001）与总生存期独立相关。多变量分析显示，甲胎蛋白水平≥100 ng/mL（HR，1.690；95% CI，1.316 - 2.170；p < 0.001）和PNI≥47（HR，0.696；95% CI，0.528 - 0.918；p = 0.010）与无进展生存期独立相关。PNI组间的累积总生存期和无进展生存期差异有统计学意义（分别为p < 0.001和p < 0.002）。在白蛋白 - 胆红素1级患者（n = 173）中使用逆概率加权调整的亚组分析中，单变量Cox风险分析显示PNI≥47（HR，0.502；95% CI，0.260 - 0.991；p = 0.047）与总生存期显著相关。样条曲线分析显示，PNI约为34 - 48是预测良好总生存期和无进展生存期的合适临界值。
结论
PNI作为营养状况的生物标志物，可预测接受阿替利珠单抗/贝伐珠单抗治疗的HCC患者的预后，即使是那些因肝功能良好而被认为预后良好的患者。
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