Prognostic value of nutritional-inflammatory markers in patients with unresectable hepatocellular carcinoma receiving immune checkpoint inhibitor therapy: a systematic review and meta-analysis

Background: This study aims to evaluate the prognostic value of baseline nutritional-inflammatory markers in patients with unresectable hepatocellular carcinoma (HCC) receiving immune checkpoint inhibitor (ICI)-based therapy. Methods: Following the PRISMA statement, a systematic review was conducted. Results: A total of 47 studies were included, involving 8483 patients. Elevated NLR (HR: 2.46, 95% CI: 1.99–3.04), PLR (HR: 2.21, 95% CI: 1.48–3.31), SII (HR: 1.73, 95% CI: 1.09–1.25), mGPS (1 vs 0, HR: 2.18, 95% CI: 1.14–4.18; 2 vs 0, HR: 2.82, 95% CI: 1.33–5.96), and SIRI (HR: 2.69, 95% CI: 1.7–4.25), as well as reduced PNI (HR: 0.55, 95% CI: 0.41–0.73) and GNRI (low vs high, HR: 1.77, 95% CI: 1.31–2.38), were significantly associated with poorer overall survival. Similarly, higher NLR (HR: 1.85, 95% CI: 1.54–2.23), PLR (HR: 1.8, 95% CI: 1.39–2.32), SII (HR: 1.61, 95% CI: 1.23–2.10), SIRI (HR: 2.61, 95% CI: 1.27–5.39), and lower PNI (HR: 0.71, 95% CI: 0.57–0.87) were linked to poorer progression-free survival. Subgroup analysis indicated that lower cutoffs for NLR (2.165–3) may enhance prognostic stratification of overall survival. The certainty of evidence for key outcomes ranged from low to moderate, which is attributed to the presence of bias and heterogeneity. Conclusion: Nutritional-inflammatory biomarkers, especially NLR for OS, show significant prognostic value in unresectable HCC patients receiving ICI therapy and may help guide personalized treatment.