Purpose: To investigate the prognostic value of post-treatment prognostic nutritional index (PNI) in advanced hepatocellular carcinoma (HCC) patients treated with immune‑based therapy, and explore its correlation with nutritional-inflammatory markers and treatment response. Methods: This retrospective study enrolled 133 patients with unresectable or metastatic HCC who received first- or second-line immune-based regimens (February 2019–September 2022). Patients were stratified by median post-treatment PNI (46.3). Survival was analyzed using Kaplan-Meier and Cox regression methods; subgroup interaction, Spearman correlation, and ROC analyses were also performed. Results: Significant baseline differences in Child-Pugh grade, vascular invasion, tumor size, baseline PNI, and median follow-up were observed between groups (all P 0.05); for OS, effect modification was suggested for tumor number (interaction P = 0.036) and AFP level (interaction P = 0.035). Post-treatment PNI positively correlated with albumin ( r = 0.862) and lymphocyte count ( r = 0.632), and negatively with NLR ( r = − 0.429) and CRP ( r = − 0.354). It showed moderate discriminatory ability for objective response (AUC = 0.663). Dynamic change in PNI (ΔPNI) lacked prognostic significance. Median follow-up was 17.2 months. Conclusion: Post‑treatment PNI is an independent prognostic biomarker in advanced HCC treated with immune‑based therapy, closely reflecting nutritional-inflammatory status and showing moderate discriminatory ability for treatment response. Dynamic PNI changes provided no incremental prognostic value in this cohort. Keywords: hepatocellular carcinoma, immunotherapy, prognostic nutritional index, nutritional status, inflammation
Chen et al. (Mon,) studied this question.