The value of prognostic nutritional index in predicting the survival of Egyptian patients with advanced hepatocellular carcinoma treated with sorafenib and regorafenib

Abstract Objectives This investigation aims to assess the prognostic significance of the pre-therapeutic prognostic nutritional index (PNI) in individuals with hepatocellular carcinoma (HCC) undergoing treatment with either sorafenib or regorafenib. Methods A retrospective cohort study was conducted on 150 patients with Barcelona Clinic Liver Cancer (BCLC) stage B/C HCC treated with sorafenib (n = 130) or regorafenib (n = 20) between September 2021 and January 2024. PNI was calculated as 10 × albumin (g/dL) + 0.005 × lymphocyte count (/mm 3 ). Outcomes included overall survival (OS), progression-free survival (PFS), and radiological response (mRECIST). Results A PNI cutoff of 40.6 (sensitivity: 70%, specificity: 61%) stratified patients into high and low PNI groups. High PNI was significantly associated with longer OS in both sorafenib (6 vs. 3.3 months, P < 0.001) and regorafenib (8 vs. 3.7 months, P < 0.01) cohorts. Similarly, PFS was significantly prolonged in high PNI patients (sorafenib: 4.95 vs. 3 months; regorafenib: 7.7 vs. 3.1 months). Multivariate analysis confirmed high PNI and low albumin–bilirubin score (ALBI) score as independent predictors of OS and PFS. Conclusions Pretreatment PNI is a reliable, cost-effective predictor of OS and PFS in advanced HCC patients treated with sorafenib or regorafenib. Alongside Child–Pugh and ALBI scores, PNI may help guide personalized treatment strategies by identifying patients most likely to benefit.