Abstract: Objective To investigate the value of preoperative inflammatory indexes, including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and prognostic nutritional index (PNI), in predicting the prognosis of hepatocellular carcinoma (HCC) after hepatectomy. Methods This retrospective cohort study selected patients who underwent hepatectomy in the Third People's Hospital of Sichuan from June 2015 to March 2018 as the research subjects, and the follow-up was as of January 2021. The main outcome was overall survival (OS). The prognostic values of preoperative NLR, PLR and PNI were evaluated by restricted cubic spline, Cox proportional hazard regression model, time-dependent receiver operating characteristic (ROC) curve and nomogram. Results A total of 77 patients reached the standard analysis, including 59 males, with a median age of 51 years. The results of restricted cubic spline analysis showed that the death risk of HCC patients was linearly related to NLR, PLR, and PNI (non-linear P>0.05), and the Cox proportional hazard regression model showed that NLR, PLR, PNI, tumor differentiation degree and tumor envelope integrity were factors affecting OS. The AUC of 1-year and 3-year OS rates predicted by nomogram model constructed by NLR, PLR, PNI were greater than that of NLR, PLR, and PNI (all P<0.05). The AUC would be further improved after the combination of the degree of tumor differentiation and tumor envelope integrity (all P<0.05). Conclusions Preoperative inflammatory indexes NLR, PLR and PNI have good efficacy in predicting the prognosis of patients undergoing hepatectomy, and the combination of clinical factors can further improve the predictive performance.

Key words: Hepatocellular carcinoma, Inflammatory indicators, NLR, PLR, PNI