Abstract
OBJECTIVE: This study incorporated preoperative inflammatory scores to develop and validate a nomogram to predict overall survival in patients with hepatocellular carcinoma following curative resection. METHODS: The study included 402 postoperative hepatocellular carcinoma patients, divided into training (n = 281) and test (n = 121) cohorts. Variables were analyzed using Cox proportional hazards model. The nomogram's performance was assessed using receiver operating characteristic curves, calibration curves, and decision curve analysis. RESULTS: Multivariable Cox proportional hazards model analysis identified neutrophil-to-lymphocyte ratio-lymphocyte-to-monocyte ratio score (HR = 4.19, 95% CI 2.47-7.12), microvascular invasion (HR = 4.93, 95% CI 2.74-8.85), and total tumor volume (HR = 1.67, 95% CI 1.03-2.68) as independent prognostic factors (P < 0.05). The nomogram exhibited excellent discriminatory ability, with area under the curve values for 12-, 36-, and 60-month overall survival in the test cohort measuring 0.941, 0.810, and 0.881. Calibration curves verified a high degree of consistency, with a Brier score of 0.054, 0.120, and 0.102, between the predicted and observed survival probabilities in the test cohort. Decision curve analysis confirmed clinical utility across a wide threshold probability range (0.15-0.70). CONCLUSION: The nomogram integrating neutrophil-to-lymphocyte ratio-lymphocyte-to-monocyte ratio score, microvascular invasion, and total tumor volume effectively identifies high-risk hepatocellular carcinoma patients with shorter overall survival. This tool provides clinicians with new evidence for risk-stratified interventions.