Prognostic value of preoperative inflammatory markers in patients with hepatocellular carcinoma underwent curative resection

Abstract Background: The prognosis of hepatocellular carcinoma (HCC) is not optimistic. Our study focused on present inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), gamma-glutamyl transpeptidase-to-platelet ratio (GPR), aspartate aminotransferase-to-lymphocyte ratio (ALR) and fibrinogen-to-albumin ratio (FAR), and aimed to explore their optimal combination for the prognosis of HCC after resection.Methods: 347 HCC patients with curative resection were enrolled. The optimal cutoff values of the inflammatory markers were calculated using receiver operating characteristic (ROC) curve analysis, and used to divide patients into two groups whose differences were compared by Kaplan-Meier analysis. Cox univariate and multivariate analysis were used to analyze the independent prognostic inflammatory markers. c2 test was chosen to determine the relationship between independent prognostic inflammatory markers and clinicopathological features. We created the combined scoring models and evaluated them by Cox univariate and multivariate methods. The concordance index (C-index), Akaike information criterion (AIC) and likelihood ratio were calculated to compare the models. The selected optimal inflammatory markers and their combinations were tested in different stages of HCC by Kaplan-Meier analysis.Results: ALR and GPR were independent prognostic factors for DFS; ALR, PLR, and GPR were independent prognostic factors for OS. The proposed GPR and ALR-GPR-PLR score models were independent predictors for DFS and OS, respectively.Conclusion: The preoperative GPR and ALR-GPR-PLR score models were independent predictors for DFS and OS, respectively, and performed well in stratifying patients with HCC. The higher score in the model, the worse the prognosis was.