Prognostic Significance of Complete Blood Counts-Derived Inflammatory Markers in Compensated Hepatocellular Carcinoma.

BACKGROUND: Inflammation-based indices derived from complete blood counts (CBC) have emerged as potential prognostic markers in hepatocellular carcinoma (HCC), yet their comparative value in compensated patients remains unclear. This study aimed to evaluate the prognostic significance of seven CBC-derived inflammatory markers in patients with compensated HCC. METHODS: This retrospective cohort study included 2802 patients with compensated HCC diagnosed between 2012 and 2025 at the First Affiliated Hospital of Anhui Medical University. Seven inflammatory indices (NLR, dNLR, MLR, NMLR, SIRI, SII, and AISI) were calculated from baseline blood tests. LASSO Cox regression with 10-fold cross-validation was used to select prognostically relevant indices. Restricted cubic spline (RCS) models were used to determine optimal cutoff values. Overall survival (OS) was analyzed using Kaplan-Meier curves and multivariable Cox regression models. RESULTS: MLR, NMLR, and SIRI were identified as significant prognostic markers. RCS-derived cutoffs were 0.27 for MLR, 2.62 for NMLR, and 0.84 for SIRI. Kaplan-Meier analysis showed that high levels of all three indices were significantly associated with worse OS (log-rank P < 0.001). In adjusted Cox models, high MLR (HR = 1.972, 95% CI: 1.704-2.283), NMLR (HR = 1.822, 95% CI: 1.576-2.107), and SIRI (HR = 1.736, 95% CI: 1.503-2.006) remained independently associated with poorer survival. These associations remained robust in sensitivity analyses using the complete-case dataset. CONCLUSION: These readily available and cost-effective markers (MLR, NMLR, and SIRI) may serve as useful prognostic indicators in patients with compensated HCC.