Abstract
Background/Objectives: Tumor-associated inflammation plays a crucial role in supporting tumorigenesis and the progression of oncological diseases. This study aimed to evaluate whether systemic inflammatory indices are associated with overall survival (OS) in patients with hepatocellular carcinoma (HCC) undergoing surgery. Methods: A retrospective cohort study was conducted on consecutive patients with HCC who underwent hepatic resection. Data were prospectively collected and retrospectively reviewed. The 5-year OS rate was used as the primary endpoint to stratify the values of inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), aspartate aminotransferase-to-neutrophil ratio index (ANRI), fibrinogen-to-albumin ratio (Fib-Alb), the systemic immune-inflammation index (SII), prognostic nutritional index (PNI), and aspartate aminotransferase-to-platelet ratio index (APRI), through receiver operating characteristic (ROC) curve analysis. The optimal albumin-bilirubin (ALBI) and platelet-ALBI (PALBI) cut-off points from the literature were also applied. Results: Patients included in the study were 153. The 1-, 3-, and 5-year OS rates were 81.7%, 65.2%, and 40.7%, respectively. Univariate Cox proportional hazards analysis showed that, in addition to several patient- and tumor-related characteristics and postoperative complications, elevated values of PLR, ANRI, Fib-Alb, SII, APRI, ALBI, and PALBI, as well as low PNI, were significantly associated with poorer overall survival (OS). Among these, only APRI and PNI emerged as independent prognostic factors in the multivariate analysis. Conclusions: PNI and APRI could serve as valuable inflammatory indices for predicting OS, helping to identify HCC patients who might benefit from hepatic resection. However, further prospective studies with larger cohorts are needed to validate the prognostic role of PNI and APRI.