Preoperative blood tests provide diagnostic and prognostic information about patients with hepatocellular carcinoma

Our aim was to assess parameters derived from preoperative blood tests as diagnostic or prognostic markers in patients with operable hepatocellular carcinoma (HCC).

We included 210 patients who underwent liver resection as the first treatment for suspected hepatocellular adenoma (HCA) or HCC (January 2010-December 2022). Parameters originated from preoperative complete blood count and biochemical blood tests were examined for associations with clinicopathological parameters and survival.

There were 31 cases of HCA and 179 cases of HCC. Fibrosis-4 index (FIB-4)≥0.77 provided the best diagnostic accuracy for differentiating between HCA and HCC [area under the curve: 0.914, P  < 0.001, sensitivity: 93.8%, specificity: 82.8%, positive predictive value (PPV): 96.9%, negative predictive value (NPV): 69.9%]. Patients with T2-T4 tumours had higher levels of aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT) ( P  < 0.001), liver function tests index ( P  = 0.005), platelets-liver function tests index (PLFTI) ( P  = 0.011), and α-fetoprotein (AFP) ( P  < 0.001), but the diagnostic accuracy was mediocre. Patients with moderately or poorly differentiated tumours had higher levels of FIB-4 ( P  = 0.023), and AFP ( P  = 0.001), providing high PPV (89.4 and 95.1%, respectively). Albumin to alkaline phosphatase ratio (ALB/ALP)>0.508 [hazard ratio (HR): 0.501, P  = 0.009], FIB-4>1.41 (HR: 2.272, P  = 0.007), PLFTI>0.087 (HR: 1.849, P  = 0.016), and AFP>3.1 (HR: 3.066, P  = 0.006) provided statistically significant results in relation to disease-free survival, and ALB/ALP>0.389 (HR: 0.505, P  = 0.036) provided statistically significant results in relation to overall survival.

Preoperative blood tests provide useful information in treatment-naive surgical candidates with suspected HCC regarding distinguishing from HCA, tumour differentiation, and risk of disease recurrence and death.