Prognostic Significance of Preoperative Inflammatory and Liver Fibrosis Markers in Hepatocellular Carcinoma

Prognostic heterogeneity remains a challenge in hepatocellular carcinoma (HCC) following curative resection. Inflammatory markers such as the platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), and systemic inflammation response index (SIRI), as well as liver fibrosis markers including gamma-glutamyltransferase-to-lymphocyte ratio (GLR), gamma-glutamyltransferase-to-platelet ratio (GPR), and AST-to-ALT ratio (AAR), have shown prognostic potential. This study aimed to evaluate their predictive value for survival after resection.

We retrospectively analyzed 187 patients with HCC who underwent curative resection between 2008 and 2022. Preoperative inflammatory and fibrosis markers, along with clinical variables, were assessed using univariate and multivariate Cox regression for overall survival (OS) and disease-free survival (DFS). Kaplan-Meier analysis and nomogram models were used to estimate 1-, 3-, and 5-year survival.

Multivariate analysis identified elevated SII, AAR, low PNI, tumor thrombus, and postoperative complications as independent predictors of poor OS, while only tumor thrombus and SIRI independently predicted DFS. SII, AAR, and PNI were also significantly associated with aggressive tumor characteristics. Patients with all three adverse markers (high SII, high AAR, low PNI) showed significantly poorer OS and DFS. A prognostic score incorporating these markers and nomogram models were constructed to predict OS and DFS after resection.

SII, AAR, and PNI are independent prognostic indicators for HCC following resection. The proposed prognostic score and nomograms may assist in individualized survival assessment and postoperative decision-making.