Prognostic Value of the PET/CT-Derived Maximum Standardized Uptake Value Combined with the Neutrophil-Lymphocyte Ratio in Patients with Hepatocellular Carcinoma Undergoing Hepatectomy.

We aimed to evaluate ability of a novel scoring system that combines fluorodeoxyglucose-uptake parameters and systemic inflammatory response indicators to predict hepatocellular carcinoma (HCC) prognosis. Clinical data were collected from patients with HCC who underwent hepatectomy at our hospital in 2014-2022. The tumor-to-liver ratio (TLR) was adopted as a positron emission tomography/computed tomography (PET/CT) standardized uptake value (SUV)-related indicator and calculated as the ratio of the SUV of tumor tissue to the SUV of normal liver tissue. The patients' immune microenvironment reflected the NLR. Postoperative overall survival (OS)- and disease-free survival (DFS)-related independent prognostic factors were analyzed using Cox proportional hazards regression modeling. Eighty-nine patients were included. TLR, NLR, and alpha-fetoprotein levels were independently associated with OS and DFS. The OS and DFS in the zero-point group were significantly longer than those in the one- and two-point groups. Time-dependent ROC curve analyses revealed area under the curve values of 0.830 and 0.752 for 5-year OS and DFS, respectively, for the scoring system, outperforming single evaluation indices. The proposed scoring system, which incorporates both TLR and NLR, simultaneously reflects metabolic tumor characteristics and the host's immune microenvironment, enabling more accurate patients with early to intermediate-stage HCC undergoing hepatectomy classification and better prognostic evaluation.