Predictive Value of Nutrition Indices in Advanced Hepatocellular Carcinoma Patients Treated With Lenvatinib

The prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) are simple markers that reflect immune and nutritional status. This retrospective study evaluated their prognostic significance in 276 patients with advanced hepatocellular carcinoma (HCC) who received first-line lenvatinib. PNI and GNRI were calculated based on serum albumin, lymphocyte count, and body weight. Patients were classified into high and low groups for each index. Multivariate models were used to assess their prognostic value for progression-free survival (PFS) and overall survival (OS). Higher PNI (cut-off: 45) and GNRI (cut-off: 98) scores were associated with significantly better outcomes: the high PNI and low PNI groups achieved median PFS of 7.5 vs. 4.0 months (p = 0.002) and OS of 19.3 vs. 9.8 months (p < 0.001), respectively. Similarly, the high GNRI and low GNRI groups achieved median PFS of 7.3 versus 4.7 months (p = 0.001) and OS of 21 versus 9.8 months (p < 0.001), respectively. Patients with higher indices also had higher objective response rates, lower rates of severe treatment-related adverse events, and were more likely to receive posttreatment therapies. The PNI (hazard ratio [HR]: 0.678, p = 0.018), GNRI (HR: 0.679, p = 0.031), and the combined indices (HR: 0.655, p = 0.013) independently demonstrated prognostic value for mortality in multivariate models. PNI and GNRI, both individually and in combination, are simple yet powerful tools that predict survival and treatment tolerance in patients with HCC receiving lenvatinib. Routine assessment of these indices may enhance patient stratification and guide therapeutic strategies.