Hiraoka A, Kumada T, Tada T, et al. - Since the details of nutritional status among patients with unresectable hepatocellular carcinoma (u-HCC) receiving systemic chemotherapy with lenvatinib have been evaluated in a few studies, researchers undertook this inquiry among patients with u-HCC managed with lenvatinib, to assess the prognostic/predictive worth of nutritional status utilizing Onodera’s prognostic nutritional index (O-PNI) for overall survival. The study sample included 375 cases (median age 72 years; Child-Pugh class A/B/C: n = 312/60/3; BCLC stage A/B/C/D: n = 2/159/212/2). The median survival time and time to progression were estimated to be 16.6 and 8.0 months, respectively. A good correlation between ALBI (albumin-bilirubin) score and O-PNI was identified. Based on the findings, it was concluded that OPNIC (O-PNI for Chemotherapy) grading possibly has the potential for easy substitution of mALBI (modified ALBI) grading. Lenvatinib's use was best indicated in the presence of a good nutritional status (OPNIC grade 1) or mALBI grade 1, while its use might not be appropriate with an OPNIC grade 3.