Identificador persistente para citar o vincular este elemento: https://accedacris.ulpgc.es/handle/10553/145650
Título: Concordance Index-Based Comparison of Inflammatory and Classical Prognostic Markers in Untreated Hepatocellular Carcinoma
Autores/as: Afonso-Luis, Natalia
Monescillo-Martín, Irene
Marchena Gómez, Joaquín 
Plá Sánchez, Pau 
Cruz-Benavides, Francisco
Hernández Socorro, Carmen Rosa 
Clasificación UNESCO: 32 Ciencias médicas
320101 Oncología
3205 Medicina interna
Palabras clave: Hepatocarcinoma
Neutrophil-To-Lymphocyte Ratio
Prognostic Factors
Fecha de publicación: 2025
Publicación seriada: Journal of Clinical Medicine 
Resumen: Background/Objectives: Inflammation-based markers have emerged as potential prognostic tools in hepatocellular carcinoma (HCC), but comparative data with classical prognostic factors in untreated HCC are limited. This study aimed to evaluate and compare the prognostic performance of inflammatory and conventional markers using Harrell’s concordance index (C-index). Methods: This retrospective study included 250 patients with untreated HCC. Prognostic variables included age, BCLC stage, Child–Pugh classification, Milan criteria, MELD score, AFP, albumin, Charlson comorbidity index, and the inflammation-based markers neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), Systemic Inflammation Response Index (SIRI), and Systemic Immune-inflammation Index (SIII). Survival was analyzed using Cox regression. Predictive performance was assessed using the C-index, Akaike Information Criterion (AIC), and likelihood ratio tests. Results: Among the classical markers, BCLC showed the highest predictive performance (C-index: 0.717), while NLR ranked highest among the inflammatory markers (C-index: 0.640), above the MELD score and Milan criteria. In multivariate analysis, NLR ≥ 2.3 remained an independent predictor of overall survival (HR: 1.787; 95% CI: 1.264–2.527; p < 0.001), along with BCLC stage, albumin, Charlson index, and Milan criteria. Including NLR in the model modestly improved the C-index (from 0.781 to 0.794) but significantly improved model fit (Δ–2LL = 10.75; p = 0.001; lower AIC). Conclusions: NLR is an accessible, cost-effective, and independent prognostic marker for overall survival in untreated HCC. It shows discriminative power comparable to or greater than most conventional predictors and may complement classical stratification tools for HCC.
URI: https://accedacris.ulpgc.es/handle/10553/145650
ISSN: 2077-0383
DOI: 10.3390/jcm14155514
Fuente: Journal of Clinical Medicine [EISSN 2077-0383], v. 14 (15), p. 5514 (Agosto 2025)
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