Combined impact of prognostic nutritional index, fibrinogen-to-albumin ratio, and neutrophil-to-lymphocyte ratio on surgical outcomes and prognosis in hepatocellular carcinoma.

Abstract

This study evaluated the predictive value of the prognostic nutritional index (PNI), fibrinogen-to-albumin ratio (FAR), and neutrophil-to-lymphocyte ratio (NLR) for overall survival in hepatocellular carcinoma (HCC) patients. A total of 283 HCC cases from Hunan Provincial People's Hospital were included in the analysis, with 45 additional patients as external validation. The relationship between these indices and patient prognosis was further evaluated using the Kaplan-Meier method and Cox regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive performance of these indices for overall survival (OS) and to determine the optimal cutoff values. ROC curve analysis revealed that the area under the curve (AUC) for PNI, FAR, and NLR was 0.723, 0.857, and 0.872, respectively. Multivariate analysis identified hepatitis history, intraoperative blood transfusion, FAR, NLR, and PNI as independent prognostic factors (all P<0.05). The resulting prediction model demonstrated strong performance in both the training (C-index =0.917) and external validation (C-index =0.853) cohorts, with AUCs of 0.889 and 0.931 for 6-month and 1-year prediction in the validation set, respectively. These findings suggest that preoperative levels of peripheral blood PNI, FAR, and NLR are closely associated with the surgical prognosis of HCC patients. The prognostic prediction model developed based on these indices exhibits good predictive efficacy.