Scoring system related inflammation and nutrition to predict prognoss of patients with hepatocellular carcinoma undergoing liver transplantation

Background: Hepatocellular carcinoma is a common malignant tumor in the liver. The prognostic predictive roles of inflammatory and nutrition-related markers in liver transplant patients with liver cancer remain unclear. Methods : 239 patients with hepatocellular carcinoma undergoing liver transplantation were randomly divided into a training set and a validation at a 7:3 ratio. The optimal cut-off values for each indicator were determined using Maximally Selected Rank Statistics; a risk score (RS) was constructed using LASSO-Cox regression, and the optimal cut-off value of the RS was determined in the training set. A nomogram was further established and its predictive efficacy was evaluated. Results: The risk score (RS) was ultimately included in three variables: FAR, GAR, and GPAR, with a cutoff value of 0.47. Patients in the high RS group had significantly poorer overall survival than those in the low RS group (P < 0.05), and this result was confirmed in the validation set and the subgroups meeting the Milan/Hangzhou criteria. Multivariate Cox analysis showed that high RS (HR = 2.174) and microvascular invasion (HR = 2.633) were independent risk factors. Based on these two factors, a nomogram was constructed, and the 1/3/5-year AUCs were 0.764/0.762/0.747 (training set) and 0.722/0.716/0.722 (validation set), and both calibration curves and decision curve analysis showed good consistency and clinical net benefit. Conclusion: The preoperative risk score integrating FAR, GAR and GPAR can independently predict the overall survival of HCC patients after liver transplantation, providing a simple and practical new tool for clinical rapid prognosis assessment, individualized follow-up and adjuvant treatment strategy formulation.