BMI, NLR predict survival in advanced HCC patients treated with anti-PD-1 antibody

Sex-specific sarcopaenia is not a predictor of overall survival (OS) in advanced hepatocellular carcinoma (HCC) after controlling for baseline Child Pugh score and neutrophil-to-lymphocyte ratio (NLR), suggests a study. However, baseline body mass index (BMI) and NLR may jointly predict OS in advanced HCC patients treated with anti-PD-1 antibody.

A retrospective review was carried out on 57 advanced HCC patients treated with immunotherapy at Winship Cancer Institute between 2015 and 2019. The investigators collected baseline computed tomography and magnetic resonance images at mid-L3 level, assessed for skeletal muscle density using SliceOmatic and converted to skeletal muscle index (SMI) by dividing it by height (m²).

Sex-specific sarcopaenia was defined by the median value of SMI. The bias-adjusted log-rank test determined the optimal cut for continuous inflammation biomarker. The primary outcomes was OS. Cox proportional hazard model was used to examine the association with survival.

Of the patients, 77.2 percent were male, 52.6 percent were Caucasian, 58.5 percent had Eastern Cooperative Oncology Group performance status 0-1, and 80.7 percent had Child Pugh A. Treatment was second line and beyond in 71.9 percent of patients. Median follow-up was 6 months.

Sarcopaenia cutoff was SMI 43 for males and SMI 39 for females; nearly half (49.1 percent) of the patients had sarcopaenia. Survival was shorter among those with vs without sarcopaenia (median OS, 5 vs 14.3 months; p=0.054), those with BMI <25 vs ≥25 kg/m² (5 vs 17.5 months; p=0.034), and those with NLR ≥5.15 vs <5.15 (3.6 vs 14.3 months; p<0.001).

Multivariable Cox regression model showed that higher baseline NLR correlated with worse OS (hazard ratio [HR], 4.17, 95 percent confidence interval [CI], 1.52–11.39; p=0.005). Sex-specific sarcopaenia was also associated with worse OS (HR, 1.71, 95 percent CI, 0.73–4.00; p=0.215), albeit not statistically significant, as was BMI <25 kg/m² (HR, 2.28, 95 percent CI, 0.92–5.65; p=0.076).

“In the association with progression-free survival, neither baseline BMI nor sex-specific sarcopaenia showed statistical significance,” the investigators said.