Abstract: Objective: To explore the value of nutritional and inflammatory indicators in predicting the prognosis of patients with advanced hepatocellular carcinoma (HCC) treated with combination therapy of Sintilimab and Bevacizumab.
Method: This study is a retrospective study. Totally 85 HCC patients admitted to Yongzhou Central Hospital from January 2021 to December 2021 were selected. According to the optimal critical values of nutritional indicators (prognostic nutritional index [PNI] and hemoglobin albumin lymphocyte platelet [HALP] scores) and inflammatory indicators (monocyte to high-density lipoprotein ratio [MHR], C-reactive protein to prealbumin ratio [CPR], and C-reactive protein to lymphocyte count ratio [CLR]), patients were divided into high PNI group and low PNI group, high HALP score group and low HALP score group, high MHR group and low MHR group, high CPR group and low CPR group, and high CLR group and low CLR group. Kaplan Meier method was used to analyze the survival of advanced HCC patients with different nutritional status or inflammation levels, and log rank test was used for comparison. Single factor and multiple factor Cox regression models were used to screen risk factors for overall survival in advanced HCC patients treated with combination therapy of Sintilimab and Bevacizumab. Draw receiver operator characteristic (ROC) curves to evaluate the predictive value of nutritional and inflammatory indicators for mortality in advanced HCC patients after treatment with Sintilimab combined with Bevacizumab.
Result: The disease control ratio (DCR) of the high PNI group, high HALP score group, low MHR group, low CPR group, and low CLR group were all higher than those of the low PNI group, low HALP score group, high MHR group, high CPR group, and high CLR group (84.0% vs. 65.7%, χ²=19.961, P<0.001; 84.8% vs. 66.7%, χ²=6.467, P=0.011; 87.0% vs. 64.1%, χ²=6.127, P=0.013; 92.0% vs. 65.7%, χ²=4.947, P=0.026; 84.5% vs. 63.6%, χ²=4.938, P=0.016). The overall survival of patients in the high PNI group, high HALP score group, low MHR group, low CPR group, and low CLR group was longer than that of patients in the low PNI group, low HALP score group, high MHR group, high CPR group, and high CLR group (all P<0.05). The ROC curve shows that the area under the curve (AUC) for predicting death in advanced HCC patients using PNI, HALP score, MHR, CPR, and CLR is 0.797 (95% confidence interval [95%CI]: 0.738-0.855), 0.773 (95%CI: 0.713-0.833), 0.606 (95%CI: 0.528-0.683), 0.726 (95%CI: 0.665-0.788), and 0.759 (95%CI: 0.701-0.818), respectively. The results of the multivariate Cox regression model analysis showed that PNI and HALP scores were independent protective factors affecting the prognosis of advanced HCC patients treated with combination therapy of Sintilimab and Bevacizumab, while MHR, CPR, and CLR were independent risk factors affecting the prognosis of advanced HCC patients treated with combination therapy of Sintilimab and Bevacizumab.

Key words: Advanced hepatocellular carcinoma, Nutrition, Inflammation, Sindilimab combined with Bevacizumab, Prognosis