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

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.