A preoperative inflammatory score-based nomogram predicts overall survival after curative hepatectomy for hepatocellular carcinoma

This study incorporated preoperative inflammatory scores to develop and validate a nomogram to predict overall survival in patients with hepatocellular carcinoma following curative resection. 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. 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). 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.