Objective To investigate the prognostic value of preoperative systemic immune-inflammation index ( SII) and fibrinogen-to-albumin-ratio ( FAR) for the postoperative overall survival (OS) of patients with Child-Pugh grade A hepatocellular carcinoma (HCC). Methods SII,FAR,laboratory examination data,clinical pathology and follow-up data were collected from 121 patients with HCC who underwent surgery. Receiver operating characteristic ( ROC) curve was used to analyze the optimal cutoff values for SII,FAR and other clinical indicators to group the patients. The associations of SII and FAR with clinical pathological characteristics of the patients were analyzed. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors affecting OS of the patients with HCC and construct a nomogram prediction model. The diagnostic performance of the model was evaluated using C-index,calibration curve and time-dependent ROC curve. The predictive ability of the model was assessed through integrated discrimination improvement ( IDI ),net reclassification index (NRI),and decision curve analysis (DCA). Results ROC curve showed that the optimal cut-off value for SII was 362 . 876,which was used to divide the patients into a high SII group (>362 . 876,n=56 ) and a low SII group (≤362 . 876,n=65 ) . The best cut-off value for FAR was 0.075,which was used to divided the patients into a high FAR group (≥0.075,n=69 ) and a low FAR group (<0.075,n=52 ) . Kaplan-Meier analysis showed that the low SII and low FAR groups had significantly better OS than the high SII and high FAR groups did ( P<0.005 ) . Univariate and multivariate Cox regression analyses showed that tumor maximum diameter,red blood cell count ( RBC),fibrinogen ( Fg),SII,and FAR were independent risk factors affecting OS of the patients with HCC (P<0.05). A nomogram was constructed. After internal validation for the nomogram,the C-index was 0.696 (0.551 –0.841),and the areas under the curve (AUCs) for predicting OS of 1,3,and 5 years were 0.739,0.744 and 0.776,respectively. The calibration curve,NRI/IDI,and DCA curves suggested that the model had certain effectiveness in predicting the survival. Conclusion Preoperative SII and FAR are correlated with the prognosis of patients with Child-Pugh grade A HCC. The patients with the high SII and FAR levels have poor prognosis.
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