BACKGROUND

Advanced hepatocellular carcinoma (HCC) with ascites (AS) lacks reliable biomarkers for predicting treatment outcomes. The combined prognostic value of the systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) remains underexplored for novel therapies.

AIM

To evaluate the clinical efficacy of combining intraperitoneal compound Kushen injection (CKI) with immunotherapy in patients with advanced HCC using a scoring system that combines SII and PNI.

METHODS

SII and PNI were calculated prior to treatment from peripheral blood samples, and critical values were determined by receiver operating characteristic analysis. SII-PNI scores were categorized as follows: 2, high SII (≥ 558.5) and low PNI (≤ 33.58); 1, high SII or low PNI; and 0, neither high SII nor low PNI. After immunotherapy combined with CKI, patients with advanced HCC were evaluated using the SII-PNI scoring criteria.

RESULTS

The SII-PNI score was significantly lower in patients without concomitant AS than in those with AS ( = 0.017). Progression-free survival was significantly longer in patients with a low SII-PNI score than in those with a high SII-PNI score ( = 0.0125). Multivariate analysis identified the SII-PNI score as an independent prognostic factor for 2-year overall survival in patients with advanced HCC and AS ( < 0.001).

CONCLUSION

The pretreatment SII-PNI score is an important indicator of treatment sensitivity for patients with advanced HCC receiving intraperitoneal CKI. It also represents a crucial basis for evaluating treatment efficacy and prognosis, aiding in the identification of high-risk groups and prognosis prediction.