Association of 5-factor modified frailty index and controlling nutritional status score with overall survival in patients with unresectable hepatocellular carcinoma undergoing interventional therapy

CHEN Dailiang; LI Yongkun; LIU Lei; YOU Nan; WANG Liang; WANG Zheng; ZHENG Lu; LI Jing

doi:10.16016/j.2097-0927.202506011

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Association of 5-factor modified frailty index and controlling nutritional status score with overall survival in patients with unresectable hepatocellular carcinoma undergoing interventional therapy

Monographic Reports | 更新时间：2025-09-11

- Association of 5-factor modified frailty index and controlling nutritional status score with overall survival in patients with unresectable hepatocellular carcinoma undergoing interventional therapy
- Journal of Army Medical University Vol. 47, Issue 17, Pages: 2061-2070(2025)
- 作者机构：
  
  陆军军医大学（第三军医大学）第二附属医院肝胆胰外科，重庆
- 作者简介：
  
  LI Jing， E-mail： xqyylj@tmmu.edu.cn
- 基金信息：
  
  General Project of Chongqing Technology Innovation and Application Development Special Program(CSTB2024TIAD-GPX0013)
- DOI：10.16016/j.2097-0927.202506011
  CLC： R459.3;R730.7;R735.7
- Received：05 June 2025，
  
  Revised：2025-08-10，
  
  Accepted：15 August 2025，
  
  Published：15 September 2025
- 稿件说明：
移动端阅览
陈代亮，李勇坤，刘磊，等.5因子改良衰弱指数联合营养状态评分与不可切除肝癌患者介入治疗后总生存期的相关性分析［J］.陆军军医大学学报，2025，47（17）：2061-2070.DOI：10.16016/j.2097-0927.202506011.

CHEN D L，LI Y K，LIU L，et al.Association of 5-factor modified frailty index and controlling nutritional status score with overall survival in patients with unresectable hepatocellular carcinoma undergoing interventional therapy［J］.J Army Med Univ，2025，47（17）：2061-2070.DOI：10.16016/j.2097-0927.202506011.
陈代亮，李勇坤，刘磊，等.5因子改良衰弱指数联合营养状态评分与不可切除肝癌患者介入治疗后总生存期的相关性分析［J］.陆军军医大学学报，2025，47（17）：2061-2070.DOI：10.16016/j.2097-0927.202506011. DOI：

CHEN D L，LI Y K，LIU L，et al.Association of 5-factor modified frailty index and controlling nutritional status score with overall survival in patients with unresectable hepatocellular carcinoma undergoing interventional therapy［J］.J Army Med Univ，2025，47（17）：2061-2070.DOI：10.16016/j.2097-0927.202506011. DOI：

摘要

目的

探究5因子改良衰弱指数（5-factor modified frailty index，mFI-5）联合控制营养状况评分（controlling nutritional status score，CONUT）、那不勒斯预后评分（Naples prognostic score，NPS）对不可切除肝细胞癌（unresectable hepatocellular carcinoma，uHCC）患者介入治疗后总生存期的相关性。

方法

采用回顾性队列研究设计，纳入2017年10月至2021年12月陆军军医大学第二附属医院肝胆胰外科收治的292例接受介入治疗的uHCC患者。根据mFI-5（≥1分）、NPS（≥

3分）和CONUT（≥4分）评分将患者分为高危组与低危组，通过倾向评分匹配（propensity score matching，PSM）平衡基线特征（匹配后

=186）。主要观察终点为总生存期（overall survival，OS），采用Kaplan-Meier法绘制生存曲线（Log-rank检验），采用受试者工作特征（receiver operating characteristic curve，ROC）曲线对联合指标预测效能进行评价，并采用Cox回归分析预后因素。

结果

PSM后2组在年龄、肿瘤指标、治疗相关指标等方面差异无统计学意义。生存分析结果显示，mFI-5+NPS高危组死亡风险增加2.252倍（95%

：1.60~3.18，

0.001）。mFI-5与NPS评分联合预测3年OS的曲线下面积（area under curve，AUC）为0.718，显著优于单一指标（

=0.007）。多因素Cox回归证实，mFI-5+NPS双阳性（

=1.46，95%

：1.01~2.11，

=0.044）、门静脉癌栓（

=1.49，95%

：1.03~2.16，

=0.035）、肿瘤直径

5 cm（

=2.01，95%

：1.27~3.17，

=0.003）、巴塞罗那临床肝癌分期（Barcelona clinic liver cancer，BCLC） C期（

=2.05，95%

：1.37~3.07，

0.001）为独立不良预后因素，术后靶向-免疫联合治疗显著降低死亡风险（

=0.57，95%

：0.39~0.81，

=0.002）。

结论

mFI-5与NPS联合评估与uHCC患者介入治疗后OS显著相关，为临床风险分层和个体化治疗提供依据。

Abstract

Objective

To investigate the correlation between the combined assessment of preoperative 5-factor modified frailty index (mFI-5) and Naples prognostic score (NPS) with overall survival in patients with unresectable hepatocellular carcinoma (uHCC) following interventional therapy.Methods‍　 ‍A retrospective cohort study enrolled 292 patients with uHCC who underwent interventional therapy at the Department of Hepatobiliary Pancreatic Surgery of the Second Affiliated Hospital in Army Medical University from October 2017 to December 2021. Patients were stratified into high-risk and low-risk groups based on mFI-5 (≥1)

NPS (≥3)

and CONUT (≥4) scores. Propensity score matching (PSM) was performed to balance baseline characteristics (post-matching

=186). The primary endpoint was overall s

urvival (OS)

analyzed using Kaplan-Meier curves with log-rank tests. The predictive performance of combined indicators was evaluated by receiver operating characteristic (ROC) curves

and prognostic factors were assessed

via

Cox regression analysis.

Results

After PSM

baseline characteristics (including age

tumor markers

and treatment-related parameters) showed no significant differences between the two groups. Survival analysis demonstrated a 2.252-fold higher risk of death in the mFI-5 plus NPS high-risk group (95%

:1.60~3.18

0.001). The combination of mFI-5 and NPS scores yielded an area under curve (AUC) of 0.718 for predicting 3-year overall survival

significantly outperforming either index alone (

=0.007). Multivariable Cox regression analysis identified that dual positivity for mFI-5 and NPS (

=1.46; 95%

: 1.01~2.11

=0.044)

portal vein tumor thrombosis (

=1.49; 95%

: 1.03~2.16

=0.035)

tumor diameter

5 cm (

HR=

2.01; 95%

:1.27~3.17

=0.003)

Barcelona clinic liver cancer (BCLC) stage C disease (

HR=

2.05; 95%

: 1.37~3.07

0.001) were independent predictors of poor prognosis. Postoperative combination targeted therapy and immunotherapy was associated with significantly reduced mortality risk (

HR=

0.57; 95%

: 0.39~0.81

=0.002).

Conclusion

The combination of mFI-5 and NPS scores is significantly associated with overall survival in patients with unresectable hepatocellular carcinoma (uHCC) undergoing locoregional therapy

providing a validated tool for clinical risk stratification and personalized treatment planning.

关键词

Keywords

references

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