Open AccessThe role of PNI to predict survival in advanced hepatocellular carcinoma treated with Sorafenib
Author(s) -
Francesco Caputo,
Vincenzo Dadduzio,
Francesco Tovoli,
Giulia Bertolini,
Giuseppe Cabibbo,
Krisida Cerma,
Caterina Vivaldi,
Luca Faloppi,
Mario Domenico Rizzato,
Fabio Piscaglia,
Ciro Celsa,
Lorenzo Fornaro,
Giorgia Marisi,
Fabio Conti,
Nicola Silvestris,
Marianna Silletta,
Sara Lonardi,
Alessandro Granito,
Caterina Stornello,
Valentina Massa,
Giorgio Astara,
Sabina Delcuratolo,
Stefano Cascinu,
Mario Scartozzi,
Andrea CasadeiGardini
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0232449
Subject(s) - sorafenib , medicine , hepatocellular carcinoma , multivariate analysis , cohort , oncology , univariate analysis , univariate , gastroenterology , multivariate statistics , statistics , mathematics
Background and aims The present study aims to investigate the role of the prognostic nutritional index (PNI) on survival in patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib. Methods This multicentric study included a training cohort of 194 HCC patients and three external validation cohorts of 129, 76 and 265 HCC patients treated with Sorafenib, respectively. The PNI was calculated as follows: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm 3 ). Univariate and multivariate analyses were performed to investigate the association between the covariates and the overall survival (OS). Results A PNI cut-off value of 31.3 was established using the ROC analysis. In the training cohort, the median OS was 14.8 months (95% CI 12–76.3) and 6.8 months (95% CI 2.7–24.6) for patients with a high (>31.3) and low (<31.3) PNI, respectively. At both the univariate and the multivariate analysis, low PNI value (p = 0.0004), a 1-unit increase of aspartate aminotransferase (p = 0.0001), and age > 70 years (p< 0.0038) were independent prognostic factors for OS. By performing the same multivariate analysis of the training cohort, the PNI <31.3 versus >31.3 was found to be an independent prognostic factor for predicting OS in all the three validation cohorts. Conclusions PNI represents a prognostic tool in advanced HCC treated with first-line Sorafenib. It is readily available and low-cost, and it could be implemented in clinical practice in patients with HCC.