Evaluation of Treatment Outcomes Using dNLR and GNRI in Combination Therapy With Atezolizumab and Bevacizumab for Hepatocellular Carcinoma

Aim: This study aims to investigate the clinical utility of the derived neutrophil-to-lymphocyte ratio (dNLR) and the Geriatric Nutritional Risk Index (GNRI) in predicting treatment outcomes for patients with unresectable hepatocellular carcinoma (HCC) undergoing combination therapy with atezolizumab and bevacizumab (Atez/Bev). Methods: A retrospective analysis was conducted on 310 patients. The dNLR, NLR, and GNRI were calculated, and their impact on progression-free survival (PFS) and overall survival (OS) was assessed. The formula for calculating dNLR is: (neutrophil count divided by [white blood cell count-neutrophil count]), which means it does not require lymphocyte count. Furthermore, GNRI-dNLR and GNRI-NLR scores were defined, and their prognostic values were also analyzed. Results: The median PFS of this cohort was 7.2 months (95% CI: 5.9-8.5), and the median OS was 24.9 months (95% CI: 19.6-30.2). The dNLR, NLR, and GNRI were significant predictors of both PFS and OS. The dNLR showed a significant correlation with the NLR (Pearson correlation coefficient, p < 0.0001). Patients with high GNRI-dNLR scores demonstrated significantly worse PFS and OS compared to those with low scores (p = 0.001, p < 0.001, respectively). Compared to stratification by GNRI alone, the GNRI-dNLR or GNRI-NLR provided better stratification for both PFS and OS. Conclusion: The dNLR could be a valuable substitute for NLR as a prognostic marker in patients with unresectable HCC undergoing Atez/Bev therapy. It offers a feasible alternative for databases lacking lymphocyte count information, ensuring comprehensive patient stratification and outcome prediction. The GNRI-NLR or GNRI-dNLR score provided better stratification compared to GNRI alone.