Hepatic immune prognostic index as a prognostic biomarker in hepatocellular carcinoma patients treated with transarterial chemoembolization

Background: Due to hepatocellular carcinoma (HCC) heterogeneity, the prognosis of patients who receive transarterial chemoembolization (TACE) treatment varies greatly. A thorough pre-treatment assessment is necessary to identify suitable candidates for TACE. Objective: To develop a hepatic immune prognostic index (HIPI) using neutrophil-to-lymphocyte ratio (NLR) and alpha-fetoprotein (AFP), and evaluate its prognostic value in patients with unresectable HCC undergoing TACE. Design: This retrospective study reviewed 663 patients with unresectable HCC who received TACE. Based on biomarkers, patients were categorized into two cohorts: HIPI-low ( n = 125) and HIPI-high ( n = 538) groups. Methods: Baseline clinical characteristics and specific biomarkers were collected and analyzed to develop the HIPI. HIPI was defined as high if NLR ⩾3 or AFP ⩾20 ng/mL, and low if both were below these cutoffs. Survival curves were compared using the Kaplan–Meier method and the log-rank test. Cox proportional hazards regression models and 1:1 propensity score matching (PSM) analysis were applied to assess the independent prognostic value of the HIPI and to adjust for baseline confounding factors. Prognostic factors affecting treatment efficacy were also analyzed. Results: Before PSM, the HIPI-low group had significantly longer median overall survival (OS; 26.0 vs 12.4 months, p < 0.001) and median progression-free survival (PFS; 9.4 vs 5.5 months, p < 0.001) than the HIPI-high group. After PSM (113 pairs), the survival advantage for the HIPI-low group remained significant (median OS: 26.7 vs 17.6 months, p < 0.001; median PFS: 8.5 vs 8.1 months, p = 0.0004). The HIPI-low group also achieved a significantly higher objective response rate and disease control rate, both before and after PSM. Univariate and multivariate analyses identified high HIPI as an independent risk factor for worse OS (hazard ratio (HR), 1.812; p < 0.001) and PFS (HR, 1.548; p < 0.001). Conclusion: The pretreatment HIPI, derived from NLR and AFP, is a potent and independent prognostic biomarker for patients with unresectable HCC treated with TACE. It effectively facilitates risk stratification and treatment decision-making.