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World J Gastroenterol. Dec 21, 2025; 31(47): 113776
Published online Dec 21, 2025. doi: 10.3748/wjg.v31.i47.113776
Comparison of the prognostic value of different inflammation-based scores in patients with hepatocellular carcinoma after Lenvatinib therapy
Wei-Jie Wu, Ze-Yu Wu, Dan-Dan Hu, Zhong-Guo Zhou, Min-Shan Chen, Yao-Jun Zhang, Zhen-Yun Yang, Jin-Bin Chen
Wei-Jie Wu, Ze-Yu Wu, Dan-Dan Hu, Zhong-Guo Zhou, Min-Shan Chen, Yao-Jun Zhang, Zhen-Yun Yang, Jin-Bin Chen, Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Wei-Jie Wu, Ze-Yu Wu, Dan-Dan Hu, Zhong-Guo Zhou, Min-Shan Chen, Yao-Jun Zhang, Zhen-Yun Yang, Jin-Bin Chen, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Wei-Jie Wu, Ze-Yu Wu, Dan-Dan Hu, Zhong-Guo Zhou, Min-Shan Chen, Yao-Jun Zhang, Zhen-Yun Yang, Jin-Bin Chen, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Co-first authors: Wei-Jie Wu and Ze-Yu Wu.
Co-corresponding authors: Zhen-Yun Yang and Jin-Bin Chen.
Author contributions: Wu WJ, Wu ZY, Hu DD, Zhou ZG, Chen MS, Zhang YJ, Yang ZY and Chen JB designed research; Wu WJ, Wu ZY, Yang ZY and Chen JB performed research (including data collection and curation); Wu ZY, Hu DD, Zhou ZG, Chen MS, Zhang YJ, Yang ZY and Chen JB contributed new reagents or analytic tools (including software and resources support); Wu WJ analyzed data; Wu WJ, Chen MS, Zhang YJ, Yang ZY and Chen JB wrote the paper (including manuscript drafting, review and editing). All authors have read and approved the final manuscript. All authors made a significant contribution to the work reported and approved the submitted manuscript. Wu WJ and Wu ZY should be considered joint first author. Chen JB was primarily responsible for key tasks such as developing the framework of the manuscript, coordinating sample data, providing guidance on data analysis, and overseeing manuscript revisions and resubmission. Meanwhile, Yang ZY made significant contributions in supervising the quality of sample data, screening data, guiding the application of statistical methods, and providing direction for manuscript drafting and revision. Their division of responsibilities covers the entire research process from "design-implementation-analysis-drafting", and neither role is dispensable. In addition, both corresponding authors were deeply involved in academic decision-making and content guidance throughout the study, effectively ensuring the scientific rigor of the manuscript drafting process. Therefore, the designation of two corresponding authors for this research is a comprehensive consideration based on the professionalism of their divided responsibilities and the dual nature of academic accountability, making it fully necessary.
Supported by Natural Science Foundation of China, No. 82103566.
Institutional review board statement: This study was conducted according to the ethical guidelines of the 1975 Declaration of Helsinki. The research was approved by the Institutional Review Board of Sun Yat-sen University Cancer Center (Approval No. B2023-673-01).
Informed consent statement: This study is a retrospective study. All data are derived from anonymous clinical data that have been collected and archived during the routine diagnosis and treatment process in the hospital. No additional interventional procedures were performed on patients during the study, and there was no direct contact with patients or potential risks to their physical and mental health. Therefore, we apply to waive the requirement for patients' informed consent.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Data sharing statement: All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Bin Chen, PhD, Department of Liver Surgery, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou 510060, Guangdong Province, China. chenjb@sysucc.org.cn
Received: September 3, 2025
Revised: September 29, 2025
Accepted: October 29, 2025
Published online: December 21, 2025
Processing time: 107 Days and 19 Hours
Abstract
BACKGROUND

Inflammation is closely related to survival and disease progression in patients with cancer. However, the predictive value of inflammation-based scores for survival in patients with hepatocellular carcinoma (HCC) treated with Lenvatinib has not been fully elucidated.

AIM

To compare different inflammation scores' prognostic values, and establish novel nomogram for predicting overall survival (OS) in HCC patients on Lenvatinib.

METHODS

In total, 144 patients with HCC treated with Lenvatinib were enrolled in this study. The prognostic value of pre-treatment inflammation-based scores was retrospectively analyzed, including the platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, lymphocyte-to-C-reactive protein ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, C-reactive protein-to-albumin ratio, and prognostic nutritional index (PNI). Kaplan-Meier survival curves and time-dependent receiver operating characteristic analysis were used to assess predictive accuracy. Univariate and multivariate Cox regression analyses were conducted to identify prognostic factors predicting OS and construct a prognostic nomogram.

RESULTS

All the inflammation-based scores demonstrated good discrimination in terms of OS (all P < 0.05), and the PNI emerged as an independent predictor of OS in multivariate analysis (hazard ratio = 4.097; 95% confidence interval: 1.405-11.944; P = 0.01). We selected three independent prognostic factors (macrovascular invasion, metastasis, and PNI) to generate a nomogram for OS.

CONCLUSION

The PNI is a prognostic indicator for assessing OS in patients with HCC treated with Lenvatinib and is superior to other inflammation-based scores in predicting OS.

Keywords: Inflammation-based score; Hepatocellular carcinoma; Lenvatinib; Overall survival; Prognostic index; Nomogram

Core Tip: This study compared the prognostic value of multiple inflammation-based scores in patients with hepatocellular carcinoma treated with Lenvatinib. The prognostic nutritional index (PNI) emerged as an independent predictor of overall survival and was superior to the other scores. A nomogram incorporating the PNI was established, facilitating personalized clinical decisions.