Prognostic value of immune-inflammation and nutritional indices in advanced hepatocellular carcinoma patients receiving immunotherapy with compound Kushen injection.

Background: Advanced hepatocellular carcinoma (HCC) with ascites (AS) lacks reliable biomarkers for predicting treatment outcomes. The combined prognostic value of the systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) remains underexplored for novel therapies.

Aim: To evaluate the clinical efficacy of combining intraperitoneal compound Kushen injection (CKI) with immunotherapy in patients with advanced HCC using a scoring system that combines SII and PNI.

Methods: SII and PNI were calculated prior to treatment from peripheral blood samples, and critical values were determined by receiver operating characteristic analysis. SII-PNI scores were categorized as follows: 2, high SII (≥ 558.5) and low PNI (≤ 33.58); 1, high SII or low PNI; and 0, neither high SII nor low PNI. After immunotherapy combined with CKI, patients with advanced HCC were evaluated using the SII-PNI scoring criteria.

Results: The SII-PNI score was significantly lower in patients without concomitant AS than in those with AS ( = 0.017). Progression-free survival was significantly longer in patients with a low SII-PNI score than in those with a high SII-PNI score ( = 0.0125). Multivariate analysis identified the SII-PNI score as an independent prognostic factor for 2-year overall survival in patients with advanced HCC and AS ( < 0.001).

Conclusion: The pretreatment SII-PNI score is an important indicator of treatment sensitivity for patients with advanced HCC receiving intraperitoneal CKI. It also represents a crucial basis for evaluating treatment efficacy and prognosis, aiding in the identification of high-risk groups and prognosis prediction.