The preoperative LDL-C to HDL-C ratio evaluates prognosis in hepatocellular carcinoma patients after hepatectomy

BACKGROUND: The regulation of lipid metabolism significantly influences the pathogenesis and advancement of hepatocellular carcinoma (HCC). As core conventional indicators of lipid metabolism, both low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) have been demonstrated to be associated with HCC. However, the prognostic value of their ratio (LHR) in HCC patients after hepatectomy has not been established. MATERIALS AND METHODS: This retrospective analysis encompassed a cohort of individuals diagnosed 415 patients with HCC who underwent liver resection at Meizhou People’s Hospital between June 2011 and January 2023. Patients were stratified into high-LHR and low-LHR groups based on optimal preoperative LHR cutoff values. Survival curves were generated using the Kaplan-Meier approach, and intergroup disparities in overall survival (OS) were assessed via log-rank testing. Univariate and multivariate Cox proportional hazards regression models further assessed LHR’s independent prognostic value. Additionally, this study developed and validated a nomogram model that incorporates independent prognostic factors identified through multivariate analysis. RESULTS: LHR was significantly correlated with multiple clinicopathological characteristics, including sex, presence of cirrhosis, portal hypertension status, tumor size and grade. In HCC patients undergoing initial hepatectomy, both LHR and Advanced Lung Cancer Inflammation Index (ALI) have significant prognostic value-particularly when combined with clinicopathological factors such as tumor number, surgical method, and TNM stage, where their predictive efficacy is even more pronounced. CONCLUSIONS: High LHR is an independent prognostic factor associated with poorer postoperative OS in HCC patients. Combining it with ALI and relevant clinicopathological characteristics significantly improves the accuracy of postoperative risk stratification and prognostic prediction.