老年营养风险指数作为阿替利珠单抗联合贝伐单抗治疗肝细胞癌时营养状况的一种易于使用的评估工具。

Geriatric nutritional risk index as an easy-to-use assessment tool for nutritional status in hepatocellular carcinoma treated with atezolizumab plus bevacizumab.

作者信息

Hiraoka Atsushi, Kumada Takashi, Tada Toshifumi, Hirooka Masashi, Kariyama Kazuya, Tani Joji, Atsukawa Masanori, Takaguchi Koichi, Itobayashi Ei, Fukunishi Shinya, Tsuji Kunihiko, Ishikawa Toru, Tajiri Kazuto, Ochi Hironori, Yasuda Satoshi, Toyoda Hidenori, Ogawa Chikara, Nishimura Takashi, Hatanaka Takeshi, Kakizaki Satoru, Shimada Noritomo, Kawata Kazuhito, Naganuma Atsushi, Kosaka Hisashi, Matono Tomomitsu, Kuroda Hidekatsu, Yata Yutaka, Ohama Hideko, Tada Fujimasa, Nouso Kazuhiro, Morishita Asahiro, Tsutsui Akemi, Nagano Takuya, Itokawa Norio, Okubo Tomomi, Arai Taeang, Imai Michitaka, Koizumi Yohei, Nakamura Shinichiro, Iijima Hiroko, Kaibori Masaki, Hiasa Yoichi

机构信息

Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.

Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan.

出版信息

Hepatol Res. 2023 Oct;53(10):1031-1042. doi: 10.1111/hepr.13934. Epub 2023 Jun 28.

DOI:10.1111/hepr.13934

PMID:37306040

Abstract

AIM

The present study focused on Geriatric Nutritional Risk Index (GNRI), which is based on bodyweight and serum albumin, and known as an easy-to-use nutritional assessment tool in clinical settings, to elucidate the prognostic predictive ability of GNRI in patients treated with atezolizumab plus bevacizumab (Atez/Bev) for hepatocellular carcinoma (HCC).

METHODS

A total of 525 HCC patients treated with Atez/Bev, based on their classification of unsuitable status for curative treatments and/or transarterial catheter chemoembolization, were enrolled (Child-Pugh A:B:C = 484:40:1, Barcelona Clinic Liver Cancer stage 0:A:B:C:D = 7:25:192:283:18). Prognosis was evaluated retrospectively using GNRI.

RESULTS

Atez/Bev was used in 338 of the present cohort as first-line systemic chemotherapy (64.4%). Median progression-free survival based on GNRI indicating normal, mild decline, moderate decline, and severe decline was 8.3, 6.7, 5.3, and 2.4 months, respectively, whereas median overall survival was 21.4, 17.0, 11.5. and 7.3 months, respectively (both p < 0.001). The concordance index (c-index) values of GNRI for predicting prognosis (progression-free survival/overall survival) were superior to those of Child-Pugh class and albumin-bilirubin grade (0.574/0.632 vs. 0.527/0.570 vs. 0.565/0.629). As a subanalysis, muscle volume loss was observed in 37.5% of 256 patients with computed tomography data available. Along with GNRI decline, frequency of muscle volume loss became progressively larger (normal vs. mild vs. moderate vs. severe = 17.6% vs. 29.2% vs. 41.2% vs. 57.9%, p < 0.001), and a GNRI value of 97.8 was predictive of its occurrence (AUC 0.715, 95% CI 0.649-0.781; specificity/sensitivity = 0.644/0.688).

CONCLUSION

These findings indicate that GNRI is an effective nutritional prognostic tool for predicting prognosis and muscle volume loss complication in HCC patients treated with Atez/Bev.

摘要

目的

本研究聚焦于老年营养风险指数（GNRI），其基于体重和血清白蛋白，是临床环境中一种易于使用的营养评估工具，旨在阐明GNRI对接受阿替利珠单抗联合贝伐单抗（阿替利珠单抗/贝伐单抗，Atez/Bev）治疗的肝细胞癌（HCC）患者的预后预测能力。

方法

纳入525例接受Atez/Bev治疗的HCC患者，这些患者基于其不适合根治性治疗和/或经动脉导管化疗栓塞的分类（Child-Pugh A:B:C = 484:40:1，巴塞罗那临床肝癌分期0:A:B:C:D = 7:25:192:283:18）。使用GNRI对预后进行回顾性评估。

结果

本队列中338例患者将Atez/Bev用作一线全身化疗（64.4%）。基于GNRI显示正常、轻度下降、中度下降和重度下降的无进展生存期分别为8.3、6.7、5.3和2.4个月，而总生存期分别为21.4、17.0、11.5和7.3个月（两者p < 0.001）。GNRI预测预后（无进展生存期/总生存期）的一致性指数（c指数）值优于Child-Pugh分级和白蛋白-胆红素分级（0.574/0.632对0.527/0.570对0.565/0.629）。作为一项亚分析，在有计算机断层扫描数据的256例患者中，37.5%观察到肌肉体积减少。随着GNRI下降，肌肉体积减少的频率逐渐增加（正常对轻度对中度对重度 = 17.6%对29.2%对41.2%对57.9%，p < 0.001），GNRI值97.8可预测其发生（AUC 0.715，95% CI 0.649 - 0.781；特异性/敏感性 = 0.644/0.688）。