老年营养风险指数和新开发的评分系统对接受乐伐替尼治疗的不可切除肝细胞癌患者的预后预测

Geriatric nutritional risk index and newly developed scoring system as prognosis prediction for unresectable hepatocellular carcinoma patients treated with lenvatinib.

作者信息

Ohama Hideko, Hiraoka Atsushi, 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, Tanaka Hironori, Nishikawa Hiroki, Shibata Hiroshi, 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, Kumada Takashi

机构信息

Gastroenterology Center, Ehime Prefectural Central Hospital, 83, Kasuga-Machi, Matsuyama, Ehime, 790-0024, Japan.

Department of Gastroenterology, Takarazuka City Hospital, Hyogo, Japan.

出版信息

Sci Rep. 2025 Jan 2;15(1):72. doi: 10.1038/s41598-024-78539-4.

DOI:10.1038/s41598-024-78539-4

PMID:39747852

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11696502/

Abstract

In the current era of immune therapy, lenvatinib (LEN) continues to be vital for treating unresectable hepatocellular carcinoma (uHCC) patients. This study investigates the importance of nutritional status in the prognosis of uHCC patients receiving LEN and evaluates a new prognostic scoring system that combines the geriatric nutritional risk index (GNRI) and systemic inflammatory response. From 2018 to 2022, 484 uHCC patients treated with LEN (384 males, median age 73). Prognostic value was compared between GNRI and C-reactive protein (CRP) scoring (GNRI-C score), GNRI, and neo-Glasgow prognostic score (neo-GPS). Evaluation was based on the Akaike information criterion (AIC) and concordance index(c-index). Median progression-free survival (mPFS) was 9.3/6.8/4.6 months for GNRI no-risk/low-risk/moderate-to-major risk (p < 0.01, AIC 4742.4/c-index 0.585). Median overall survival (mOS) was 27.8/15.2/9.5 months (p < 0.01, AIC 3433.34/c-index 0.639). For GNRI-C score, mPFS was 10.8/7.1/5.6/4.0 months (score 0/1/2/3) (p < 0.01, AIC 4732.82/c-index 0.6), while neo-GPS showed mPFS of 8.5/5.1/5.2 months (p < 0.01, AIC 4745.89/c-index 0.562). For mOS, GNRI-C score demonstrated 28.6/20.0/10.1/8.4 months (score 0/1/2/3) (p < 0.01, AIC 3420.27/c-index 0.652), while neo-GPS indicated 21.0/12.4/4.5 months (p < 0.01, AIC 3468.84/c-index 0.564). The newly devised GNRI-C score, incorporating nutritional and inflammatory markers, could offer improved prognostic predictions for uHCC patients treated with LEN.

摘要

在当前免疫治疗时代，乐伐替尼（LEN）对于治疗无法切除的肝细胞癌（uHCC）患者仍然至关重要。本研究调查了营养状况在接受LEN治疗的uHCC患者预后中的重要性，并评估了一种结合老年营养风险指数（GNRI）和全身炎症反应的新预后评分系统。2018年至2022年，484例接受LEN治疗的uHCC患者（384例男性，中位年龄73岁）。比较了GNRI与C反应蛋白（CRP）评分（GNRI-C评分）、GNRI和新格拉斯哥预后评分（neo-GPS）的预后价值。评估基于赤池信息准则（AIC）和一致性指数（c指数）。GNRI无风险/低风险/中度至重度风险患者的中位无进展生存期（mPFS）分别为9.3/6.8/4.6个月（p<0.01，AIC 4742.4/c指数0.585）。中位总生存期（mOS）分别为27.8/15.2/9.5个月（p<0.01，AIC 3433.34/c指数0.639）。对于GNRI-C评分，mPFS分别为10.8/7.1/5.6/4.0个月（评分0/1/2/3）（p<0.01，AIC 4732.82/c指数0.6），而neo-GPS显示mPFS为8.5/5.1/5.2个月（p<0.01，AIC 4745.89/c指数0.562）。对于mOS，GNRI-C评分分别为28.6/20.0/10.1/8.4个月（评分0/1/2/3）（p<0.01，AIC 3420.27/c指数0.652），而neo-GPS分别为21.0/12.4/4.5个月（p<0.01，AIC 3468.84/c指数0.564）。新设计的GNRI-C评分结合了营养和炎症标志物，可为接受LEN治疗的uHCC患者提供更好的预后预测。