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PROGNOSTIC VALUE OF GNRI-C SCORE FOR UNRESECTABLE HEPATOCELLULAR CARCINOMA PATIENTS TREATED WITH LENVATINIB – MULTICENTER RETROSPECTIVE STUDY

Hideko Ohama 1, Atsushi Hiraoka 1, Toshifumi Tada 2, Takeshi Hatanaka 3, Hidenori Toyoda 4, Kazunari Tanaka 5, Hidekatsu Kuroda 6, Tomomitsu Matono 7, Fujimasa Tada 1, Joji Tani 8, Satoru Kakizaki 9, Kazuhiro Nouso 10, Masaki Kaibori 11, Yoichi Hiasa 12, Takashi Kumada 13

Affiliations

1 Ehime Prefectural Central Hospital, Matsuyama, Japan

2 Kobe University Graduate School of Medicine, Kobe, Japan

3 Gunma Saiseikai Maebashi Hospital, Maebashi, Japan

4 Ogaki Municipal Hospital, Ogaki, Japan

5 Teine Keijinkai Hospital, Sapporo, Japan

6 Iwate Medical University School of Medicine Dept. of Internal Medicine, Morioka, Japan

7 Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan

8 Faculty Of Medicine, Kagawa University, Miki-cho, Kita-gun,, Japan

9 NHO Takasaki General Medical Center, Takasaki, Japan

10 Okayama City Hospital, Okayama, Japan

11 Kansai Medical University, Hirakata, Japan

12 Ehime University Graduate School of Medicine, Toon, Japan

13 Gifu Kyoritsu University, Ogaki, Japan

Summary

AI Generated

A multicenter retrospective study of 484 unresectable hepatocellular carcinoma patients treated with lenvatinib demonstrates that GNRI-C score, which combines geriatric nutritional risk index with C-reactive protein levels, predicts survival outcomes better than other prognostic scoring systems.

GNRI-C score integrates nutritional status (based on serum albumin, height, and body weight) with inflammatory marker CRP (adding 1 point for CRP ≥1 mg/dL), creating a 0-3 point scale that stratified 484 patients into four risk groups
Median overall survival decreased stepwise across GNRI-C score groups from 28.61 months (score 0) to 8.21 months (score 3), and median progression-free survival decreased from 10.79 months to 3.68 months (both p <0.001)
Treatment response rates (ORR and DCR) and adverse event incidence did not differ significantly among GNRI-C score groups
GNRI-C outperformed GNRI, mALBI grade, NLR, O-PNI, and neo-GPS in predicting overall survival, showing the lowest Akaike Information Criterion score of 2887.19
The authors conclude this simple scoring system may help clinicians identify high-risk patients and support treatment decisions in unresectable HCC patients receiving lenvatinib

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Lenvatinib (LEN) remains an important treatment option for unresectable hepatocellular carcinoma (uHCC) patients in the present immunotherapy era. Based on the recognized impact of nutritional status and systemic inflammatory response on cancer treatment outcomes, this study evaluated uHCC patients treated with LEN to determine the prognostic significance of a newly developed combination of geriatric nutritional risk index (GNRI) and the systemic inflammatory response marker C-reactive protein (CRP), known as GNRI-C score.

Aims & Methods

This multicenter retrospective study included 484 patients with uHCC who received LEN between 2018 and 2022. Initially, GNRI score was calculated to assess nutritional status based on serum albumin level, height, and body weight, with the cohort categorized into three groups; score 0 (GNRI >98), score 1 (GNRI 92–98), and score 2 (GNRI <92). Next, GNRI-C score, which integrates GNRI-based risk stratification with CRP level, with an additional 1 point assigned for CRP ≥1 mg/dL, used to classify the patients into four groups (score 0, 1, 2, or 3). In this manner, GNRI-C score was considered to provide a comprehensive assessment by incorporating both nutritional status and inflammation caused by the presence of a hepatocellular carcinoma. Treatment outcomes, including objective response rate (ORR), disease control rate (DCR) determined using RECIST v.1.1, progression-free survival (PFS), overall survival (OS), and impact of GNRI-C score on prognosis, were subsequently analyzed.

Results

The median follow-up period was 12.9 months. Patient median age was 73 years and 79.3% were male. A GNRI-C score of 0 was noted in 220, 1 in 109, 2 in 106, and 3 in 49 patients. For GNRI-C scores of 0, 1, 2, and 3, treatment response analysis showed ORR values of 51.3%, 45.7%, 50.0%, and 38.9%, respectively, and DCR values of 84.8%, 83.0%, 85.1%, and 83.3%, respectively, with no significant differences (p = 0.517, p = 0.963, respectively). Similarly, adverse event incidence rates did not significantly differ among the patient groups formed by GNRI-C score. On the other hand, for patients grouped based on GNRI-C score of 0, 1, 2, and 3, median PFS was significantly different at 10.79, 7.46, 5.75, and 3.68 months, respectively (p <0.001), as was median OS at 28.61, 19.64, 10.25, and 8.21 months, respectively (p <0.001). Even for patients who received lenvatinib as first-line therapy, significant differences for PFS (9.86, 7.46, 6.43, and 4.25 months, respectively) and OS (34.57, 20.14, 10.75, and 8.21 months, respectively) were noted when divided using GNRI-C score (p <0.001). Finally, comparative prognostic analysis demonstrated the superiority of GNRI-C over other scoring systems, as the Akaike Information Criterion score for OS prediction was lowest for GNRI-C (2887.19), outperforming GNRI, mALBI grade, NLR, O-PNI, and neo-GPS.

Conclusion

GNRI-C score, which integrates nutritional and inflammatory markers, is considered to be a superior prognostic tool for assessing uHCC patients undergoing LEN treatment. This simple and objective scoring system may aid clinicians in identifying high-risk patients and also optimizing treatment strategies.

Conference

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Abstract

Session

Developments in HCC management: From diagnosis to therapy (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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