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Background <p>The prognostic nutritional index (PNI), reflecting both nutritional and immune status, may be associated with survival in hepatocellular carcinoma (HCC) patients treated with immune checkpoint inhibitors (ICIs). However, findings across individual studies remain inconsistent. This meta-analysis aimed to assess the association between pretreatment PNI and survival outcomes in HCC patients receiving ICIs.</p> Methods <p>A systematic search of PubMed, Embase, and Web of Science was conducted from inception to May 31, 2025. Cohort studies reporting hazard ratios (HRs) for overall survival (OS) and/or progression-free survival (PFS) by baseline PNI levels in HCC patients on ICIs were included. Pooled HRs with 95% confidence intervals (CIs) were calculated using random-effects models to account for the influence of heterogeneity.</p> Results <p>Eleven retrospective cohort studies with 2,944 patients were included. A low PNI was significantly associated with poorer OS (HR: 1.78, 95% CI: 1.40 to 2.26, <i>p</i> &lt; 0.001; I² = 56%) and PFS (HR: 1.46, 95% CI: 1.22 to 1.74, <i>p</i> &lt; 0.001; I² = 43%). Subgroup analyses showed consistent associations across mean age, Barcelona Clinic Liver Cancer stage C proportion, PNI cutoff, follow-up duration, and study quality scores, with all <i>p</i>-values for subgroup differences &gt; 0.05. Sensitivity analyses by excluding one study at a time did not significantly affect the results, which also confirmed the stability of findings.</p> Conclusions <p>Low pretreatment PNI was associated with poorer OS and PFS in HCC patients receiving ICIs. These findings suggest that PNI may be a promising and practical prognostic marker in this setting. However, prospective studies are needed to validate its utility before it can be considered an established biomarker.</p>

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Prognostic nutritional index and the survival of patients with hepatocellular carcinoma on immune checkpoint inhibitors: a meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月6日

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  • Jia Fu,
  • Wei Peng,
  • Jinqiong Jiang,
  • Tan Deng,
  • Huaxin Duan,
  • Kanghan Liu

摘要

Background

The prognostic nutritional index (PNI), reflecting both nutritional and immune status, may be associated with survival in hepatocellular carcinoma (HCC) patients treated with immune checkpoint inhibitors (ICIs). However, findings across individual studies remain inconsistent. This meta-analysis aimed to assess the association between pretreatment PNI and survival outcomes in HCC patients receiving ICIs.

Methods

A systematic search of PubMed, Embase, and Web of Science was conducted from inception to May 31, 2025. Cohort studies reporting hazard ratios (HRs) for overall survival (OS) and/or progression-free survival (PFS) by baseline PNI levels in HCC patients on ICIs were included. Pooled HRs with 95% confidence intervals (CIs) were calculated using random-effects models to account for the influence of heterogeneity.

Results

Eleven retrospective cohort studies with 2,944 patients were included. A low PNI was significantly associated with poorer OS (HR: 1.78, 95% CI: 1.40 to 2.26, p < 0.001; I² = 56%) and PFS (HR: 1.46, 95% CI: 1.22 to 1.74, p < 0.001; I² = 43%). Subgroup analyses showed consistent associations across mean age, Barcelona Clinic Liver Cancer stage C proportion, PNI cutoff, follow-up duration, and study quality scores, with all p-values for subgroup differences > 0.05. Sensitivity analyses by excluding one study at a time did not significantly affect the results, which also confirmed the stability of findings.

Conclusions

Low pretreatment PNI was associated with poorer OS and PFS in HCC patients receiving ICIs. These findings suggest that PNI may be a promising and practical prognostic marker in this setting. However, prospective studies are needed to validate its utility before it can be considered an established biomarker.