Prognostic nutritional index as a prognostic factor for very early-stage hepatocellular carcinoma

Abstract

Introduction: Field factors play more important roles in predicting the outcomes of patients compared with tumor factors in early-stage hepatocellular carcinoma (HCC). However, the prognostic ability of non-invasive serum marker scores for hepatic fibrosis and liver functional reserve on very early-stage HCC is still not yet determined. We aimed to investigate the performance of these serum marker scores in predicting the prognoses of patients with very early-stage HCC. Methods: A total of 446 patients with the very early-stage HCC from 2012 to 2022 were retrospectively enrolled. Serum biomarkers and prognostic scores determining overall survival (OS) were analyzed by Cox proportional hazards model. We compared the Akaike information criterion (AIC) among the prognostic nutritional index (PNI), AST to Platelet Ratio Index (APRI), albumin-bilirubin (ALBI) score, EZ (easy)-ALBI score, modified ALBI score, fibrosis (FIB)-4 score and lymphocyte-to-monocyte ratio (LMR) to determine the predictability on the OS. Results: After a median follow-up of 41.0 months (interquartile range IQR 36.9-45.1 months), 81 patients died, with a 5-year OS rate of 71.0%. Among the non-invasive serum marker scores, PNI had the best performance in predicting the OS with the lowest AIC (846.407) compared to other scores. Moreover, we stratified the patients into high-risk (PNI<45) and low-risk (PNI>=45) groups. It showed that the 5-year OS rates were 83.4% and 60.8% in the low-risk and high-risk PNI groups, respectively (p<0.001). Conclusions: PNI had the best performance in predicting the OS for patients with very early-stage HCC.