Traditional clinical predictors outperform ALBI, NLR, and PLR after curative hepatic resection for HCC in a Western cohort.

[BACKGROUND] Oncological characteristics and underlying liver function influence the outcomes of patients with hepatocellular carcinoma. The Albumin-Bilirubin (ALBI) score, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are predictive instruments. However, for patients undergoing hepatic resection, their value remains unclear, particularly in Western populations.

[METHODS] ALBI, NLR and PLR were derived from blood tests obtained prior to surgery in 156 consecutive patients who underwent R0 hepatic resections between 2015 and 2020 at a Western academic center. Associations with overall survival (OS) and progression-free survival (PFS) were analyzed using Kaplan-Meier methods and Cox regression models.

[RESULTS] Median age was 60 years; 72 % of patients were male, and 45 % had underlying cirrhosis. On univariate analysis, ALBI grade was associated with OS and PFS and NLR with OS, but neither retained significance in multivariate models. PLR was not predictive. Cirrhosis (HR 2.32), ECOG performance status ≥2 (HR 2.67), and AFP >100 ng/mL (HR 2.89) were independently associated with worse OS in multivariate analysis. Tumor number ≥2 and AFP >100 ng/mL were two independent predictors for PFS.

[CONCLUSION] ALBI, NLR and PLR did not emerge as clinically relevant predictive value for OS and PFS in patients undergoing resection for HCC.