Zhu YF, Zhang DW, Zhang M, Yu MH, Zhang SH, Wu YY. Prognostic value of immune-inflammation and nutritional indices in advanced hepatocellular carcinoma patients receiving immunotherapy with compound Kushen injection. World J Gastrointest Oncol 2025; 17(7): 106684 [DOI: 10.4251/wjgo.v17.i7.106684]
Corresponding Author of This Article
Yong-Fu Zhu, PhD, The First Department of Oncology, The First Affiliated Hospital of Anhui University of Chinese Medicine, No. 117 Meishan Road, Hefei 230031, Anhui Province, China. zyf240@ahtcm.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Jul 15, 2025; 17(7): 106684 Published online Jul 15, 2025. doi: 10.4251/wjgo.v17.i7.106684
Prognostic value of immune-inflammation and nutritional indices in advanced hepatocellular carcinoma patients receiving immunotherapy with compound Kushen injection
Yong-Fu Zhu, Dong-Wei Zhang, Ming-Hui Yu, Shao-Hu Zhang, Yue-Yue Wu, The First Department of Oncology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
Ming Zhang, The Second Department of Oncology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
Author contributions: Zhu YF, Wu YY, and Zhang M participated in the research design, performed the research, and wrote the manuscript; Zhang DW and Zhang SH collected the data; Zhu YF and Yu MH contributed to critically revision of the manuscript; all authors thoroughly reviewed and endorsed the final manuscript.
Supported by the 2022 Anhui Provincial Health Commission Scientific Research Project, No. AHWJ2022b053; the 2022 Scientific Research Project of Anhui University of Chinese Medicine, No. 2022AH050415; the Horizontal Project, No. 2022HZ009; and the 2024 Open Project of the Key Laboratory of Xin’an Medicine, Ministry of Education, No. 2024xayx02.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, approval No. 2024MCZQ09.
Informed consent statement: Written informed consent was not required due to the retrospective design of the study.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
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: Yong-Fu Zhu, PhD, The First Department of Oncology, The First Affiliated Hospital of Anhui University of Chinese Medicine, No. 117 Meishan Road, Hefei 230031, Anhui Province, China. zyf240@ahtcm.edu.cn
Received: March 28, 2025 Revised: April 21, 2025 Accepted: June 10, 2025 Published online: July 15, 2025 Processing time: 108 Days and 5.2 Hours
Abstract
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 (P = 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 (P = 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 (P < 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.
Core Tip: A scoring system that combines the systemic immune-inflammation index and prognostic nutritional index is effective in evaluating treatment response and prognosis in advanced hepatocellular carcinoma patients receiving immunotherapy and compound Kushen injection. The systemic immune-inflammation index-prognostic nutritional index score identifies patients at high risk, predicts progression-free and overall survival, and supports personalized treatment planning. By improving the inflammatory and nutritional status, compound Kushen injection enhances the therapeutic outcomes of immunotherapy, particularly in hepatocellular carcinoma patients with ascites. This scoring system contributes to a more refined assessment of patient prognosis and a deeper understanding of the interplay between nutrition, immunity, and inflammation in hepatocellular carcinoma management.
