Prognostic Nutritional Index May Be Associated With Survival in HCC

Researchers argue that Onodera’s prognostic nutritional index, calculated by lymphocytes and serum albumin to determine nutritional and immune status, is a straightforward method for use among patients undergoing liver surgery.

Looking into the prognostic value of inflammatory and nutritional markers in hepatocellular carcinoma (HCC), researchers say a nutritional index can be leveraged to determine severity and prognosis.

Their findings were published in Medicine.

The researchers argue that Onodera’s prognostic nutritional index (OPNI), which is calculated by lymphocytes and serum albumin to determine nutritional and immune status, is a simplistic and straightforward method for use among patients undergoing liver surgery.

“Even after hepatectomy, because of low postoperative survival rate and high recurrence rate, the prognosis of HCC patients is still poor,” wrote the researchers. “The severity and prognosis of HCC are determined by multiple factors, such as infections of viral hepatitis, metastasis, and treatment methods. There, it is particularly important to use a simple and easily measured indicator to determine the prognosis of HCC.”

The researchers collected data from 270 patients with HCC, finding that the index, treatment choice (surgery vs conservation), platelet-to-lymphocyte ratio, and Barcelona Clinic Liver Cancer (BCLC) stage were independently prognostic when it came to survival, according to multivariate analysis.

Among these factors, OPNI had the biggest influence on survival: Patients with higher index scores had superior survival. The index has previously shown prognostic use in other cancers like small cell lung cancer, clear cell renal cell carcinoma, colorectal cancer, and pancreatic cancer.

“In future clinical work, OPNI can be calculated routinely before surgery in patients with hepatocellular carcinoma,” explained the researchers. When OPNI is low, it often indicates that the patients are in a state of malnutrition and poor immune function. Therefore, enteral or parenteral nutrition treatment can be given before surgery to improve the overall prognosis of the patients.”

Because HCC prognosis is closely associated with liver function, the group dug deeper into the correlation between OPNI, BCLC stage, and albumin-bilirubin (ALBI) grade—a model for assessing liver dysfunction. They found that patients who were BCLC stage C and D had significantly lower mean (SD) OPNI than patients who were stage 0:

  • Stage 0 vs stage C: 49.05 (1.263) vs 45.05 (0.7012) (P = .0102)
  • Stage 0 vs stage D: 49.05 (1.263) vs 39.04 (3.447) (P = .0037)

In addition, patients who were ALBI grade 2 and 3 had lower mean OPNI than patients with ALBI grade 1:

  • Grade 1 vs grade 2: 51.39 (0.3174) vs 44.02 (1.122) (P <.0001)
  • Grade 1 vs grade 3: 51.39 (0.3174) vs 32.03 (3.077) (P <.0001)

Survival curve analyses showed that advanced BCLC stage and higher ALBI grade were associated with poorer overall survival among individuals with HCC, and the authors concluded that “OPNI can be used as an auxiliary indicator to help assess the severity and prognosis” of these patients.

Reference

Xu Y, Yuan X, Zhang X, et al. Prognostic value of inflammatory and nutritional markers for hepatocellular carcinoma. Medicine (Baltimore). Published online June 25, 2021. doi:10.1097/MD.0000000000026506