Bati Imam Bakir, Tuysuz Umut, Eygi Elif
Department of Liver Transplant Surgery, Faculty of Medicine, Acıbadem University, Istanbul 34752, Turkey.
Department of Liver Transplant Surgery, Şişli Etfal Hamidiye Training and Research Hospital, Istanbul 34360, Turkey.
Curr Oncol. 2025 Aug 16;32(8):464. doi: 10.3390/curroncol32080464.
Hepatocellular carcinoma (HCC) remains a major indication for liver transplantation (LT), but accurate pretransplant risk stratification is critical to improve long-term outcomes. Traditional morphometric criteria such as tumor size and number are limited in predicting recurrence and survival. The HALP (hemoglobin, albumin, lymphocyte, platelet), gamma-glutamyl transpeptidase to platelet ratio (GPR), and FIB-4 indices are emerging systemic inflammatory and nutritional biomarkers that may provide additional prognostic value in HCC patients undergoing LT. This retrospective, two-center cohort study included 200 patients who underwent LT for HCC between 2012 and 2023. Preoperative HALP, GPR, and FIB-4 scores were calculated, and their associations with overall survival (OS) and recurrence-free survival (RFS) were assessed using ROC analyses and Cox proportional hazard models. Cut-off values were determined for each biomarker, and survival outcomes were analyzed using Kaplan-Meier methods. A low HALP score (≤0.39) was independently associated with reduced OS but not with RFS. Conversely, low GPR (≤0.45) and FIB-4 (≤3.1) values were significantly associated with both poor OS and higher recurrence risk. Tumor size, number of lesions, and microvascular invasion also independently predicted poor outcomes. Multivariate analysis confirmed HALP, GPR, and FIB-4 as significant preoperative predictors of prognosis in this population. HALP, GPR, and FIB-4 are readily available, cost-effective indices that provide significant prognostic information in HCC patients undergoing LT. Their integration with morphometric criteria may improve pretransplant risk stratification and support individualized clinical decision-making.
肝细胞癌（HCC）仍然是肝移植（LT）的主要适应症，但准确的移植前风险分层对于改善长期预后至关重要。传统的形态学标准，如肿瘤大小和数量，在预测复发和生存方面存在局限性。HALP（血红蛋白、白蛋白、淋巴细胞、血小板）、γ-谷氨酰转肽酶与血小板比值（GPR）和FIB-4指数是新兴的全身炎症和营养生物标志物，可能为接受LT的HCC患者提供额外的预后价值。这项回顾性、双中心队列研究纳入了200例在2012年至2023年间接受LT治疗HCC的患者。计算术前HALP、GPR和FIB-4评分，并使用ROC分析和Cox比例风险模型评估它们与总生存期（OS）和无复发生存期（RFS）的关联。确定每个生物标志物的临界值，并使用Kaplan-Meier方法分析生存结果。低HALP评分（≤0.39）与OS降低独立相关，但与RFS无关。相反，低GPR（≤0.45）和FIB-4（≤3.1）值与OS不良和更高的复发风险均显著相关。肿瘤大小、病变数量和微血管侵犯也独立预测不良预后。多变量分析证实HALP、GPR和FIB-4是该人群术前预后的重要预测指标。HALP、GPR和FIB-4是易于获得、具有成本效益的指标，可为接受LT的HCC患者提供重要的预后信息。将它们与形态学标准相结合可能会改善移植前风险分层，并支持个体化的临床决策。
