Abstract
BACKGROUND: Enhancing prognostication in Hepatocellular Carcinoma (HCC) remains an unmet need, especially in patients with preserved liver function. This study aimed to integrate the Platelet-to-White Blood Cell Ratio (PWR) with albumin-bilirubin (ALBI) and platelets-albumin-bilirubin (PALBI) scores for improved assessment of mortality and treatment responses in hepatocellular carcinoma (HCC) patients. METHODS: In this prospective study, 262 patients with hepatocellular carcinoma (HCC) were included, with basic data collected and followed up for one year or until death. All prognostic scores were calculated by integrating the PWR with the ALBI and PALBI scores, examining their relationship with treatment responses and mortality rates. RESULTS: The patients were mainly males (69.5%), aged 59.6 ± 8.09 years. The predictive power of the integrated PALBI+PWR score at different time points 1 (P 0.004), 3 months, and 6 months (P 0.004) overpowered all other scores. However, late at the 12-month follow-up, ALBI score had reported superiority on PALPI+PWR (AUC 0.631, 0.617), respectively. Regression analyses confirmed the high performance of PALBI+PWR factors in influencing treatment response (P 0.009-OR 0.562 (0.365 - 0.867)). Regarding mortality prediction, PALPI+PWR proved the highest efficacy in regression analysis (P <0.001) OR (2.451 (1.555 - 3.862). CONCLUSION: Integrating PWR with the PALBI score enhances prognostic precision in patients with HCC, offering improved predictive power for treatment responses and mortality in the early stages of HCC with preserved liver function.