Comparison of the Prognostic Value of Inflammation-Based Scores in Patients with Hepatocellular Carcinoma After Anti-PD-1 Therapy

Jie Mei; Xu-Qi Sun; Wen-Ping Lin; Shao-Hua Li; Liang-He Lu; Jing-Wen Zou; Wei Wei; Rong-Ping Guo

doi:10.2147/JIR.S325600

Comparison of the Prognostic Value of Inflammation-Based Scores in Patients with Hepatocellular Carcinoma After Anti-PD-1 Therapy

J Inflamm Res. 2021 Aug 11:14:3879-3890. doi: 10.2147/JIR.S325600. eCollection 2021.

Authors

Jie Mei^#^{1

2}, Xu-Qi Sun^#³, Wen-Ping Lin^#^{1

2}, Shao-Hua Li^{1

2}, Liang-He Lu^{1

2}, Jing-Wen Zou^{1

2}, Wei Wei^{1

2}, Rong-Ping Guo^{1

2}

Affiliations

¹ Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
² State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
³ Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.

^# Contributed equally.

Abstract

Background: Inflammatory response is related to cancer progression and patient survival. However, the value in predicting survival in hepatocellular carcinoma (HCC) patients who received anti-PD-1 therapy has not been elucidated. This study aimed to compare the predictive ability of inflammation-based scores for the prognosis of HCC patients after anti-PD-1 therapy.

Methods: A total of 442 patients who received anti-PD-1 therapy were included in the study. Representative inflammation-based prognostic scores, including the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-C-reactive protein (CRP) ratio (LCR), lymphocyte-to-monocyte ratio (LMR), systemic immune inflammation index (SII), CRP-to-albumin ratio (CAR), prognostic nutritional index (PNI), Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), and prognostic index (PI), were assessed for prediction accuracy using Kaplan-Meier survival curves, time-dependent receiver operating characteristic (ROC) and Harrell's concordance index (C-index) analyses.

Results: All the inflammation-based prognostic scores exhibited good discriminatory ability in overall survival (OS) (all P < 0.01), while the PNI score was a unique independent predictor for OS in multivariate analysis (hazard ratio, 1.770; confidence interval, 1.309-2.393; P < 0.001). The areas under the ROC curves at 6, 12, 18 and 24 months and the C-index (0.65) demonstrated that the predictive accuracy of the PNI score was superior to that of the other inflammation-based scores.

Conclusion: The PNI score is a discriminatory prognostic indicator for OS in HCC patients with anti-PD-1 therapy and is superior to the other inflammation-based prognostic scores in terms of predictive ability.

Keywords: anti-PD-1 therapy; hepatocellular carcinoma; inflammation-based score; overall survival; prognostic nutritional index.

Grants and funding

This study was supported by the National Natural Science Foundation of China (No. 81871985); Natural Science Foundation of Guangdong Province (No. 2018A0303130098 and 2017A030310203); Science and Technology Planning Project of Guangdong Province (No. 2017A020215112); Medical Scientific Research Foundation of Guangdong Province (No. A2017477); Science and Technology Planning Project of Guangzhou (No.201903010017 and No. 201904010479); Clinical Trials Project (5010 Project) of Sun Yat-sen University (No. 5010-2017009).