Nutritional Status Is Associated with Prognosis in Patients with Advanced Unresectable Hepatocellular Carcinoma Treated with Atezolizumab plus Bevacizumab

Toshifumi Tada; Takashi Kumada; Atsushi Hiraoka; Kazuya Kariyama; Joji Tani; Masashi Hirooka; Koichi Takaguchi; Masanori Atsukawa; Shinya Fukunishi; Ei Itobayashi; Kunihiko Tsuji; Kazuto Tajiri; Hironori Ochi; Toru Ishikawa; Satoshi Yasuda; Chikara Ogawa; Hidenori Toyoda; Takeshi Hatanaka; Takashi Nishimura; Satoru Kakizaki; Kazuhito Kawata; Noritomo Shimada; Fujimasa Tada; Kazuhiro Nouso; Akemi Tsutsui; Hideko Ohama; Asahiro Morishita; Takuya Nagano; Norio Itokawa; Tomomi Okubo; Taeang Arai; Hisashi Kosaka; Michitaka Imai; Atsushi Naganuma; Shinichiro Nakamura; Yohei Koizumi; Tomomitsu Matono; Masaki Kaibori; Hiroko Iijima; Yoichi Hiasa

doi:10.1159/000527676

Nutritional Status Is Associated with Prognosis in Patients with Advanced Unresectable Hepatocellular Carcinoma Treated with Atezolizumab plus Bevacizumab

Toshifumi Tada^*, Takashi Kumada, Atsushi Hiraoka, Kazuya Kariyama, Joji Tani, Masashi Hirooka, Koichi Takaguchi, Masanori Atsukawa, Shinya Fukunishi, Ei Itobayashi, Kunihiko Tsuji, Kazuto Tajiri, Hironori Ochi, Toru Ishikawa, Satoshi Yasuda, Chikara Ogawa, Hidenori Toyoda, Takeshi Hatanaka, Takashi Nishimura, Satoru KakizakiKazuhito Kawata, Noritomo Shimada, Fujimasa Tada, Kazuhiro Nouso, Akemi Tsutsui, Hideko Ohama, Asahiro Morishita, Takuya Nagano, Norio Itokawa, Tomomi Okubo, Taeang Arai, Hisashi Kosaka, Michitaka Imai, Atsushi Naganuma, Shinichiro Nakamura, Yohei Koizumi, Tomomitsu Matono, Masaki Kaibori, Hiroko Iijima, Yoichi Hiasa

^*Corresponding author for this work

Internal Medicine （3）

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

Introduction: This study investigated the relationship between nutritional status, as determined by the prognostic nutritional index (PNI), and outcomes in patients with unresectable hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab (Atez/bev). Methods: The study analyzed 485 HCC patients treated with Atez/bev. Results: There were 342 patients with a low PNI (<47) and 143 patients with a high PNI (≥47). The median follow-up duration was 9.4 (6.0-14.3) months. Multivariate Cox hazards analysis showed that an α-fetoprotein level ≥100 ng/mL (hazard ratio (HR), 2.217; 95% confidence interval (CI), 1.588-3.095; p < 0.001), and PNI ≥47 (HR, 0.333; 95% CI, 0.212-0.525; p < 0.001) were independently associated with overall survival. Multivariate analysis showed that an α-fetoprotein level ≥100 ng/mL (HR, 1.690; 95% CI, 1.316-2.170; p < 0.001) and PNI ≥47 (HR, 0.696; 95% CI, 0.528-0.918; p = 0.010) were independently associated with progression-free survival. Cumulative overall and progression-free survival rates differed significantly by PNI (p < 0.001 and p < 0.002, respectively). In a subgroup analysis using inverse probability weighting adjustment in patients with albumin-bilirubin grade 1 (n = 173), univariate Cox hazards analysis showed that a PNI ≥47 (HR, 0.502; 95% CI, 0.260-0.991; p = 0.047) was significantly associated with overall survival. Spline curve analysis revealed that a PNI of approximately 34-48 is an appropriate cutoff for predicting good overall and progression-free survival. Conclusion: The PNI, a biomarker of nutritional status, can predict prognosis in patients with HCC treated with Atez/bev, even those who are considered to have a good prognosis due to good liver function.

Original language	English
Pages (from-to)	270-282
Number of pages	13
Journal	Oncology (Switzerland)
Volume	101
Issue number	4
DOIs	https://doi.org/10.1159/000527676
State	Published - 2023/04/01

Keywords

Atezolizumab plus bevacizumab
Hepatocellular carcinoma
Nutritional status
Prognostic nutritional index
Survival

ASJC Scopus subject areas

Oncology
Cancer Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1159/000527676

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Tada, T., Kumada, T., Hiraoka, A., Kariyama, K., Tani, J., Hirooka, M., Takaguchi, K., Atsukawa, M., Fukunishi, S., Itobayashi, E., Tsuji, K., Tajiri, K., Ochi, H., Ishikawa, T., Yasuda, S., Ogawa, C., Toyoda, H., Hatanaka, T., Nishimura, T., ... Hiasa, Y. (2023). Nutritional Status Is Associated with Prognosis in Patients with Advanced Unresectable Hepatocellular Carcinoma Treated with Atezolizumab plus Bevacizumab. Oncology (Switzerland), 101(4), 270-282. https://doi.org/10.1159/000527676

@article{ea6d79fbb2e84e7db20a87a716490980,

title = "Nutritional Status Is Associated with Prognosis in Patients with Advanced Unresectable Hepatocellular Carcinoma Treated with Atezolizumab plus Bevacizumab",

abstract = "Introduction: This study investigated the relationship between nutritional status, as determined by the prognostic nutritional index (PNI), and outcomes in patients with unresectable hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab (Atez/bev). Methods: The study analyzed 485 HCC patients treated with Atez/bev. Results: There were 342 patients with a low PNI (<47) and 143 patients with a high PNI (≥47). The median follow-up duration was 9.4 (6.0-14.3) months. Multivariate Cox hazards analysis showed that an α-fetoprotein level ≥100 ng/mL (hazard ratio (HR), 2.217; 95% confidence interval (CI), 1.588-3.095; p < 0.001), and PNI ≥47 (HR, 0.333; 95% CI, 0.212-0.525; p < 0.001) were independently associated with overall survival. Multivariate analysis showed that an α-fetoprotein level ≥100 ng/mL (HR, 1.690; 95% CI, 1.316-2.170; p < 0.001) and PNI ≥47 (HR, 0.696; 95% CI, 0.528-0.918; p = 0.010) were independently associated with progression-free survival. Cumulative overall and progression-free survival rates differed significantly by PNI (p < 0.001 and p < 0.002, respectively). In a subgroup analysis using inverse probability weighting adjustment in patients with albumin-bilirubin grade 1 (n = 173), univariate Cox hazards analysis showed that a PNI ≥47 (HR, 0.502; 95% CI, 0.260-0.991; p = 0.047) was significantly associated with overall survival. Spline curve analysis revealed that a PNI of approximately 34-48 is an appropriate cutoff for predicting good overall and progression-free survival. Conclusion: The PNI, a biomarker of nutritional status, can predict prognosis in patients with HCC treated with Atez/bev, even those who are considered to have a good prognosis due to good liver function.",

keywords = "Atezolizumab plus bevacizumab, Hepatocellular carcinoma, Nutritional status, Prognostic nutritional index, Survival",

author = "Toshifumi Tada and Takashi Kumada and Atsushi Hiraoka and Kazuya Kariyama and Joji Tani and Masashi Hirooka and Koichi Takaguchi and Masanori Atsukawa and Shinya Fukunishi and Ei Itobayashi and Kunihiko Tsuji and Kazuto Tajiri and Hironori Ochi and Toru Ishikawa and Satoshi Yasuda and Chikara Ogawa and Hidenori Toyoda and Takeshi Hatanaka and Takashi Nishimura and Satoru Kakizaki and Kazuhito Kawata and Noritomo Shimada and Fujimasa Tada and Kazuhiro Nouso and Akemi Tsutsui and Hideko Ohama and Asahiro Morishita and Takuya Nagano and Norio Itokawa and Tomomi Okubo and Taeang Arai and Hisashi Kosaka and Michitaka Imai and Atsushi Naganuma and Shinichiro Nakamura and Yohei Koizumi and Tomomitsu Matono and Masaki Kaibori and Hiroko Iijima and Yoichi Hiasa",

year = "2023",

month = apr,

day = "1",

doi = "10.1159/000527676",

language = "英語",

volume = "101",

pages = "270--282",

journal = "Oncology (Switzerland)",

issn = "0030-2414",

publisher = "S. Karger AG",

number = "4",

}

Tada, T, Kumada, T, Hiraoka, A, Kariyama, K, Tani, J, Hirooka, M, Takaguchi, K, Atsukawa, M, Fukunishi, S, Itobayashi, E, Tsuji, K, Tajiri, K, Ochi, H, Ishikawa, T, Yasuda, S, Ogawa, C, Toyoda, H, Hatanaka, T, Nishimura, T, Kakizaki, S, Kawata, K, Shimada, N, Tada, F, Nouso, K, Tsutsui, A, Ohama, H, Morishita, A, Nagano, T, Itokawa, N, Okubo, T, Arai, T, Kosaka, H, Imai, M, Naganuma, A, Nakamura, S, Koizumi, Y, Matono, T, Kaibori, M, Iijima, H & Hiasa, Y 2023, 'Nutritional Status Is Associated with Prognosis in Patients with Advanced Unresectable Hepatocellular Carcinoma Treated with Atezolizumab plus Bevacizumab', Oncology (Switzerland), vol. 101, no. 4, pp. 270-282. https://doi.org/10.1159/000527676

TY - JOUR

T1 - Nutritional Status Is Associated with Prognosis in Patients with Advanced Unresectable Hepatocellular Carcinoma Treated with Atezolizumab plus Bevacizumab

AU - Tada, Toshifumi

AU - Kumada, Takashi

AU - Hiraoka, Atsushi

AU - Kariyama, Kazuya

AU - Tani, Joji

AU - Hirooka, Masashi

AU - Takaguchi, Koichi

AU - Atsukawa, Masanori

AU - Fukunishi, Shinya

AU - Itobayashi, Ei

AU - Tsuji, Kunihiko

AU - Tajiri, Kazuto

AU - Ochi, Hironori

AU - Ishikawa, Toru

AU - Yasuda, Satoshi

AU - Ogawa, Chikara

AU - Toyoda, Hidenori

AU - Hatanaka, Takeshi

AU - Nishimura, Takashi

AU - Kakizaki, Satoru

AU - Kawata, Kazuhito

AU - Shimada, Noritomo

AU - Tada, Fujimasa

AU - Nouso, Kazuhiro

AU - Tsutsui, Akemi

AU - Ohama, Hideko

AU - Morishita, Asahiro

AU - Nagano, Takuya

AU - Itokawa, Norio

AU - Okubo, Tomomi

AU - Arai, Taeang

AU - Kosaka, Hisashi

AU - Imai, Michitaka

AU - Naganuma, Atsushi

AU - Nakamura, Shinichiro

AU - Koizumi, Yohei

AU - Matono, Tomomitsu

AU - Kaibori, Masaki

AU - Iijima, Hiroko

AU - Hiasa, Yoichi

PY - 2023/4/1

Y1 - 2023/4/1

N2 - Introduction: This study investigated the relationship between nutritional status, as determined by the prognostic nutritional index (PNI), and outcomes in patients with unresectable hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab (Atez/bev). Methods: The study analyzed 485 HCC patients treated with Atez/bev. Results: There were 342 patients with a low PNI (<47) and 143 patients with a high PNI (≥47). The median follow-up duration was 9.4 (6.0-14.3) months. Multivariate Cox hazards analysis showed that an α-fetoprotein level ≥100 ng/mL (hazard ratio (HR), 2.217; 95% confidence interval (CI), 1.588-3.095; p < 0.001), and PNI ≥47 (HR, 0.333; 95% CI, 0.212-0.525; p < 0.001) were independently associated with overall survival. Multivariate analysis showed that an α-fetoprotein level ≥100 ng/mL (HR, 1.690; 95% CI, 1.316-2.170; p < 0.001) and PNI ≥47 (HR, 0.696; 95% CI, 0.528-0.918; p = 0.010) were independently associated with progression-free survival. Cumulative overall and progression-free survival rates differed significantly by PNI (p < 0.001 and p < 0.002, respectively). In a subgroup analysis using inverse probability weighting adjustment in patients with albumin-bilirubin grade 1 (n = 173), univariate Cox hazards analysis showed that a PNI ≥47 (HR, 0.502; 95% CI, 0.260-0.991; p = 0.047) was significantly associated with overall survival. Spline curve analysis revealed that a PNI of approximately 34-48 is an appropriate cutoff for predicting good overall and progression-free survival. Conclusion: The PNI, a biomarker of nutritional status, can predict prognosis in patients with HCC treated with Atez/bev, even those who are considered to have a good prognosis due to good liver function.

AB - Introduction: This study investigated the relationship between nutritional status, as determined by the prognostic nutritional index (PNI), and outcomes in patients with unresectable hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab (Atez/bev). Methods: The study analyzed 485 HCC patients treated with Atez/bev. Results: There were 342 patients with a low PNI (<47) and 143 patients with a high PNI (≥47). The median follow-up duration was 9.4 (6.0-14.3) months. Multivariate Cox hazards analysis showed that an α-fetoprotein level ≥100 ng/mL (hazard ratio (HR), 2.217; 95% confidence interval (CI), 1.588-3.095; p < 0.001), and PNI ≥47 (HR, 0.333; 95% CI, 0.212-0.525; p < 0.001) were independently associated with overall survival. Multivariate analysis showed that an α-fetoprotein level ≥100 ng/mL (HR, 1.690; 95% CI, 1.316-2.170; p < 0.001) and PNI ≥47 (HR, 0.696; 95% CI, 0.528-0.918; p = 0.010) were independently associated with progression-free survival. Cumulative overall and progression-free survival rates differed significantly by PNI (p < 0.001 and p < 0.002, respectively). In a subgroup analysis using inverse probability weighting adjustment in patients with albumin-bilirubin grade 1 (n = 173), univariate Cox hazards analysis showed that a PNI ≥47 (HR, 0.502; 95% CI, 0.260-0.991; p = 0.047) was significantly associated with overall survival. Spline curve analysis revealed that a PNI of approximately 34-48 is an appropriate cutoff for predicting good overall and progression-free survival. Conclusion: The PNI, a biomarker of nutritional status, can predict prognosis in patients with HCC treated with Atez/bev, even those who are considered to have a good prognosis due to good liver function.

KW - Atezolizumab plus bevacizumab

KW - Hepatocellular carcinoma

KW - Nutritional status

KW - Prognostic nutritional index

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=85152152557&partnerID=8YFLogxK

U2 - 10.1159/000527676

DO - 10.1159/000527676

M3 - 学術論文

C2 - 36455517

AN - SCOPUS:85152152557

SN - 0030-2414

VL - 101

SP - 270

EP - 282

JO - Oncology (Switzerland)

JF - Oncology (Switzerland)

IS - 4

ER -

Nutritional Status Is Associated with Prognosis in Patients with Advanced Unresectable Hepatocellular Carcinoma Treated with Atezolizumab plus Bevacizumab

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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