Changes in systemic immune-inflammation index (SII) predict the prognosis of patients with hepatitis B-related hepatocellular carcinoma treated with lenvatinib plus PD-1 inhibitors

Purpose This study aimed to evaluate the prognostic significance of changes in inflammatory markers in patients with Hepatitis B virus-related hepatocellular carcinoma (HBV-HCC) treated with first-line lenvatinib plus a programmed cell death protein 1 (PD-1) inhibitor. Methods This study retrospectively included 117 HBV-HCC patients treated with first-line lenvatinib in combination with a PD-1 inhibitor. Independent factors affecting progression-free survival (PFS) and overall survival (OS) were explored based on baseline indicators and inflammatory markers changes after one treatment cycle. Results Multivariate analysis revealed that an alpha-fetoprotein (AFP) level \(\geqslant\)400 ng/mL [hazard ratio (HR), 1.69; 95% confidence interval (CI), 1.11–2.58; P = 0.01] was identified as an independent risk factor, platelet-to-neutrophil ratio (PNR) \(\leqslant\) 65.43 (HR 0.50; 95% CI 0.30–0.84; P \(< 0.01)\) and SII \(\leqslant\)539.47 (HR 0.54; 95% CI 0.30–0.96; P = 0.03) were identified as independent protective factors for PFS. Additionally, multivariate analysis demonstrated that AFP \(\geqslant\) 400 ng/mL, HBV-HCC patients with diabetes mellitus (DM), and SII \(> 303.66\) were independent risk factors of OS. The patients whose SII had increased after one cycle of treatment showed a poorer PFS (HR 1.61; 95 %CI 1.10–2.37; P = 0.015) and OS (HR 1.76; 95 % CI 1.15–2.70; P = 0.009) than patients whose SII had decreased. The objective response rate (ORR) was higher in the SII-decreased patients (47.5% vs 32.5%, P = 0.11). Mann–Whitney test found a significant difference in therapeutic response between the SII-increased patients and the SII-decreased patients (P = 0.04). Conclusion SII can be associated with outcomes in patients with HBV-HCC treated with first-line lenvatinib plus PD-1 inhibitors.