Prognostic Value of the PET/CT-Derived Maximum Standardized Uptake Value Combined with the Neutrophil–Lymphocyte Ratio in Patients with Hepatocellular Carcinoma Undergoing Hepatectomy

<b>Background:</b> We aimed to evaluate ability of a novel scoring system that combines fluorodeoxyglucose-uptake parameters and systemic inflammatory response indicators to predict hepatocellular carcinoma (HCC) prognosis. <b>Methods:</b> Clinical data were collected from patients with HCC who underwent hepatectomy at our hospital in 2014-2022. The tumor-to-liver ratio (TLR) was adopted as a positron emission tomography/computed tomography (PET/CT) standardized uptake value (SUV)-related indicator and calculated as the ratio of the SUV_max of tumor tissue to the SUV_mean of normal liver tissue. The patients' immune microenvironment reflected the NLR. Postoperative overall survival (OS)- and disease-free survival (DFS)-related independent prognostic factors were analyzed using Cox proportional hazards regression modeling. <b>Results:</b> Eighty-nine patients were included. TLR, NLR, and alpha-fetoprotein levels were independently associated with OS and DFS. The OS and DFS in the zero-point group were significantly longer than those in the one- and two-point groups. Time-dependent ROC curve analyses revealed area under the curve values of 0.830 and 0.752 for 5-year OS and DFS, respectively, for the scoring system, outperforming single evaluation indices. <b>Conclusions:</b> The proposed scoring system, which incorporates both TLR and NLR, simultaneously reflects metabolic tumor characteristics and the host's immune microenvironment, enabling more accurate patients with early to intermediate-stage HCC undergoing hepatectomy classification and better prognostic evaluation.