To evaluate the predictive value of preoperative inflammatory immune indexes for survival and prognosis of patients with hepatocellular carcinoma (HCC) undergoing hepatectomy.

Clinical data of 232 HCC patients who underwent hepatectomy in the Second Affiliated Hospital of Kunming Medical University from March 2018 to February 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 190 patients were male and 42 female, aged from 33 to 77 years, with a median age of 52 years. The optimal cut-off values of neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI) and hemoglobin, albumin, lymphocyte and platelet (HALP) scores were determined by using the ROC curve and Youden's index. Kaplan-Meier method and Log-rank test were used for survival analysis. Univariate and multivariate Cox's regression analyses were adopted to determine the independent risk factors of patients' survival and prognosis. A prediction model for prognostic index (PI) was constructed. The ROC curve was employed to analyze the prediction efficiency for 2-year overall survival of this prediction model.

During postoperative follow-up, 90 patients died and 142 survived. The 1-, 3-, and 5-year survival rates of HCC patients were 93.5%, 79.3% and 56.5%, respectively. The optimal cutoff values of NLR, LMR, SII, PNI and HALP were 2.38, 3.53, 429.89, 347.44 and 32.64, respectively. The 1- and 3-year survival rates of HCC patients in the high NLR group were 82.1% and 38.3%, respectively, and 89.6% and 68.1% in the low NLR group, respectively. The 1- and 3-year survival rates in the high LMR group were 92.0% and 69.0%, and 80.0% and 41.2% in the low LMR group, respectively. The 1- and 3-year survival rates in the high SII group were 84.6% and 37.9%, and 92.2% and 67.9% in the low SII group, respectively. The 1- and 3-year survival rates in the high PNI group were 94.0% and 75.4%, and 89.4% and 44.2% in the low PNI group, respectively. The 1- and 3-year survival rates in the high HALP group were 93.1% and 70.6%, and 60.5% and 5.0% in the low HALP group, respectively. The differences in these indexes were statistically significant between two groups (χ²=16.103, 23.882, 19.502, 23.059, 109.681; all P<0.001). Univariate and multivariate Cox's regression analyses showed that microvascular invasion, activated partial thromboplastin time, PNI and HALP were the independent prognostic factors (HR=1.667, 0.955, 0.997, 0.987; all P<0.05). PI model was constructed based on the independent prognostic factors, and the area under the ROC curve of the prediction model was 0.654.

Preoperative inflammatory immune indexes, such as NLR, LMR, SII, PNI and HALP, can predict postoperative survival of HCC patients after hepatectomy. PI model based on inflammatory immune indexes has certain predictive value for survival and prognosis.