Nomogram integrating prognostic immune-inflammatory-nutritional score with clinicopathological parameters for predicting post-transplantation outcomes in hepatocellular carcinoma

doi:10.3748/wjg.122971

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2027. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Jan 7, 2027; 33(1): 122971
Published online Jan 7, 2027. doi: 10.3748/wjg.122971

Nomogram integrating prognostic immune-inflammatory-nutritional score with clinicopathological parameters for predicting post-transplantation outcomes in hepatocellular carcinoma

Jin-Can Huang, Han-Xuan Wang, Yang Zhao, Xian-Liang Li, Qiang He, Ren Lang, Lin Zhou

Jin-Can Huang, Han-Xuan Wang, Yang Zhao, Xian-Liang Li, Qiang He, Ren Lang, Lin Zhou, Division of Hepatobiliary and Pancreaticosplenic Surgery, Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China

Jin-Can Huang, Department of Hepatobiliary Surgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222000, Jiangsu Province, China

Co-first authors: Jin-Can Huang and Han-Xuan Wang.

Co-corresponding authors: Ren Lang and Lin Zhou.

Author contributions: Huang JC and Wang HX contributed equally to this manuscript and shared the first authorship; Zhou L and Lang R were the co-corresponding authors of this research; Huang JC and Zhou L conceptualized and designed the research study; Huang JC and Wang HX performed the formal analysis, wrote the original draft; Zhao Y collected the data; Li XL and He Q provided resources; Lang R and Zhou L supervised the project and administered the study; Zhou L acquired funding for the study; Lang R and Zhou L reviewed and edited the manuscript; all authors have read and approved the final version of the manuscript.

AI contribution statement: AI tools (ChatGPT) were used for language polishing during manuscript preparation. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.

Supported by the National Natural Science Foundation of China, No. 82370665.

Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki. The study was reviewed and approved by the Ethics Committee of Beijing Chao-Yang Hospital, Capital Medical University (approval No. 2020-D-303).

Informed consent statement: Given the retrospective design, the requirement for written informed consent was waived by Ethics Committee of Beijing Chao-Yang Hospital, Capital Medical University.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.

Data sharing statement: The datasets used during the current study are available from the corresponding author (richard_fmmu@126.com) on reasonable request.

Corresponding author: Lin Zhou, MD, Doctor, Division of Hepatobiliary and Pancreaticosplenic Surgery, Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing 100020, China. richard_fmmu@126.com

Received: May 7, 2026
Revised: July 3, 2026
Accepted: July 29, 2026
Published online: January 7, 2027
Processing time: 189 Days and 20.5 Hours

Abstract

BACKGROUND

Nutritional, immune, and inflammatory status of patients are closely associated with tumor progression and prognosis. However, comprehensive prognostic indicators that integrates nutritional, immune, and inflammatory status remain limited in hepatocellular carcinoma (HCC) patients after liver transplantation (LT).

AIM

To develop a composite index prognostic immune-inflammatory-nutritional (PIIN) score and evaluating its predictive value for post-LT prognosis in HCC patients.

METHODS

This study adopted a retrospective cohort study design and included 269 HCC patients underwent LT. Nutritional, immune, and inflammatory indexes were integrated to construct the PIIN score using least absolute shrinkage and selection operator regression. A predictive nomogram was subsequently established by incorporating the PIIN score and clinicopathological variables, which was intended for perioperative or postoperative risk stratification. Its performance was evaluated using calibration curves, time-dependent receiver operating characteristic analysis, the concordance index, and decision curve analysis.

RESULTS

Neutrophil-to-lymphocyte ratio, prognostic nutritional index, platelet-to-lymphocyte ratio, systemic immune-inflammation index and systemic inflammation response index were identified to construct PIIN score. Patients with high PIIN score had significantly worse overall survival (OS) and disease-free survival (DFS) than those with low PIIN score in both training and validation cohorts after stratified according to the training-set-derived cutoff value of the PIIN score. Multivariable analysis confirmed PIIN score as an independent prognostic factor for OS [hazard ratio (HR) = 3.277, 95% confidence interval (CI): 2.270-4.731; P < 0.001] and DFS (HR = 3.007, 95%CI: 2.099-4.307; P < 0.001) in both training and validation cohort. A PIIN-based nomogram incorporating PIIN score, tumor number, tumor size, alpha fetoprotein and differentiation was developed, showing favorable discrimination, calibration, and clinical utility, with better predictive performance than conventional criteria.

CONCLUSION

PIIN score may help predict post-transplant outcomes in HCC patients. A PIIN-based model incorporating PIIN score and clinicopathological indexes may serve as a potentially useful tool for risk stratification.

Keywords: Hepatocellular carcinoma; Nomogram; Liver transplantation; Nutrition; Immunity; Inflammation

Core Tip: Although nutritional, immune and inflammatory status affect hepatocellular carcinoma (HCC) prognosis, composite indicators reflecting these factors remain unreported. We retrospectively enrolled 269 HCC patients undergoing liver transplantation and constructed a prognostic immune-inflammatory-nutritional (PIIN) score using least absolute shrinkage and selection operator regression on routine blood test-derived indicators. A PIIN-based prediction model incorporating PIIN score, tumor number, tumor size, alpha fetoprotein and differentiation was also established. A high PIIN score independently predicted worse overall and disease-free survival, showed favorable discrimination, calibration, and clinical utility superior to conventional criteria, and may serve as a practical tool for evaluating post-transplant prognosis in HCC.