Subcutaneous adipose tissue/neutrophil-to-lymphocyte ratio is a potential biomarker in patients with hepatocellular carcinoma undergoing liver resection.

Objective: Both subcutaneous adipose tissue (SAT) and neutrophil-to-lymphocyte ratio (NLR) are associated with the prognosis of hepatocellular carcinoma (HCC). Subcutaneous adipose tissue is an immunonutritional indicator, and NLR reflects the inflammatory status. The purpose of this study was to ascertain the validity of SAT/NLR as potential prognostic biomarkers in HCC patients who are undergoing liver resection.

Methods: This retrospective study encompassed the sequential enrollment of 682 patients diagnosed with HCC who underwent liver resection. The patients were categorized into high and low SAT/NLR groups using the median value, and forward stepwise logistic regression was utilized to ascertain independent predictors for one-year HCC recurrence. In order to minimize the influence of confounding variables, a propensity score matching (PSM) analysis was conducted between patients in high and low SAT/NLR groups. The Kaplan-Meier method was employed to assess and compare the recurrence-free survival (RFS) and overall survival (OS) between the two groups.

Results: The study divided patients into two groups based on their SAT/NLR levels: high SAT/NLR (≥35.34) and low SAT/NLR (<35.34) groups. Forward stepwise logistic regression analysis revealed that low SAT/NLR (p < 0.001), tumor size ≥50 mm (p < 0.001), alpha-fetoprotein level >200 ng/mL (p < 0.001), and presence of liver cirrhosis (p < 0.001) were significantly associated with one-year recurrence of HCC. Moreover, the results suggest that RFS and OS were significantly shorter in the low SAT/NLR group compared to the high SAT/NLR group, both before and after PSM (p < 0.05).

Conclusions: The preoperative biomarker SAT/NLR shows potential as a prognostic biomarker for one-year recurrence and prognosis in patients with HCC undergoing liver resection.