What question did this study set out to answer?

This research aims to assess the predictive value of the lymphocyte-to-C-reactive protein ratio for early recurrence in MVI-positive hepatocellular carcinoma patients post-surgery.

April 19, 2026BMC Cancer0 citationsOpen Access

The predictive value of the lymphocyte-C-reactive protein ratio for early recurrence in MVI positive HCC patients who underwent postoperative adjuvant transcatheter arterial chemoembolization

JSJihan Sun JFJiongze FangNingbo Medical Center Lihuili Hospital YSYuying ShanNingbo Medical Center Lihuili Hospital

Key Points

This research aims to assess the predictive value of the lymphocyte-to-C-reactive protein ratio for early recurrence in MVI-positive hepatocellular carcinoma patients post-surgery.
Retrospective evaluation of 480 HCC patients with a focus on 146 MVI-positive cases.
LCR calculated pre-surgery using lymphocyte count and C-reactive protein levels.
Assessment of LCR’s predictive value using LASSO regression, univariate and multivariate Cox regression analyses.
Development and validation of a prognostic nomogram incorporating LCR and other variables.
An LCR value ≤ 11,000 was associated with significantly worse one-year recurrence-free survival (HR = 3.268, P = 0.009).
Additional factors included alpha-fetoprotein > 20 ng/mL and tumor diameter influencing prognosis.
The combined nomogram achieved a concordance index of 0.759, indicating good predictive ability.
Time-dependent ROC analysis confirmed the model’s predictive accuracy with an AUC of 0.788.

Abstract

In this study, we evaluated the prognostic capacity of the lymphocyte-to-C-reactive protein ratio (LCR) in predicting one-year recurrence among patients with microvascular invasion (MVI)-positive hepatocellular carcinoma (HCC) who underwent postoperative adjuvant transarterial chemoembolization (PA-TACE). A total of 480 HCC patients were retrospectively enrolled in this single-center study. Among them, 146 patients with MVI-positive HCC underwent PA-TACE. The LCR was calculated prior to surgery using the formula: LCR = 104 × lymphocyte count (109/L) / C‑reactive protein (mg/L). The predictive value of LCR for early recurrence was assessed using LASSO regression, along with univariate and multivariate Cox regression analyses. A prognostic model was subsequently developed and validated through decision curve analysis (DCA) and receiver operating characteristic (ROC) curve analysis. In the nomogram model, an LCR value below 11,000 (≤ 11,000 vs. > 11,000; HR = 3.268, 95% CI: 1.346–7.936, P = 0.009) was associated with worse 1-year RFS in HCC patients who underwent PA-TACE. The nomogram also incorporated additional prognostic variables: alpha-fetoprotein (AFP) > 20 ng/mL (> 400 vs. ≤ 20; HR = 2.635, 95% CI: 1.255–5.532, P = 0.010), tumor diameter (HR = 1.153, 95% CI: 1.053–1.253, P = 0.002), ALT level (HR = 0.359, 95% CI: 0.179–0.718, P = 0.004), and MVI class (class 2 vs. class 1; HR = 2.438, 95% CI: 1.344–4.422, P = 0.003). The combined nomogram demonstrated a satisfactory discriminative ability, with a concordance index of 0.759 (95% CI: 0.694–0.825). Furthermore, time-dependent ROC analysis confirmed the model’s predictive accuracy, yielding an AUC of 0.788 (95% CI: 0.714–0.863). Both time-dependent ROC and decision curve analyses supported the clinical utility of the nomogram for recurrence risk stratification. LCR is an important prognostic factor for early recurrence in MVI-positive HCC patients who received PA-TACE. Our nomogram model combining LCR shown sufficient discrimination ability and ideal prediction capability to distinguish patients at risk for early recurrence.

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