Prognostic value of pan-immune-inflammation index in hepatocellular carcinoma compared with albumin-bilirubin and model for end-stage liver disease sodium

doi:10.4251/wjgo.v18.i7.121250

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World Journal of Gastrointestinal Oncology

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1948-5204

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

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Retrospective Cohort Study

Copyright: ©Author(s) 2026. 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 Gastrointest Oncol. Jul 15, 2026; 18(7): 121250
Published online Jul 15, 2026. doi: 10.4251/wjgo.v18.i7.121250

Prognostic value of pan-immune-inflammation index in hepatocellular carcinoma compared with albumin-bilirubin and model for end-stage liver disease sodium

Salih Karatlı, Doğan Yazılıtaş, Seher Kaya, Gökşen İ İmamoğlu, Selahattin Çelik, Galip C Uyar

Salih Karatlı, Doğan Yazılıtaş, Seher Kaya, Gökşen İ İmamoğlu, Selahattin Çelik, Galip C Uyar, Department of Medical Oncology, Ankara Etlik City Hospital, Ankara 06000, Türkiye

Author contributions: Karatlı S and Yazılıtaş D designed the study; Karatlı S performed data collection and statistical analysis, wrote the original draft; Yazılıtaş D supervised the study; Kaya S, İmamoğlu Gİ, Çelik S and Uyar GC contributed to data interpretation and manuscript revision; and all authors have read and approved the final manuscript.

Institutional review board statement: The study was reviewed and approved by the Ankara Etlik City Hospital Scientific Research Ethics Committee (Decision No: AEŞH-BADEK2-2025-438, date: September 16, 2025).

Informed consent statement: Informed consent was waived due to the retrospective design and use of anonymized data.

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 and/or analyzed during the current study are available from the corresponding author on reasonable request.

Corresponding author: Salih Karatlı, MD, Department of Medical Oncology, Ankara Etlik City Hospital, Varlık Neighborhood, Halil Sezai Erkut Avenue, Yenimahalle, Ankara 06000, Türkiye. karatlisalih@hotmail.com

Received: March 19, 2026
Revised: April 8, 2026
Accepted: April 22, 2026
Published online: July 15, 2026
Processing time: 110 Days and 16.5 Hours

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) prognosis is influenced by tumor burden, liver function, performance status, and systemic inflammation. Conventional prognostic systems such as the albumin-bilirubin (ALBI) and model for end-stage liver disease-sodium (MELD-Na) scores mainly reflect hepatic functional reserve but may not adequately capture the host inflammatory response.

AIM

To evaluate the prognostic significance of the pan-immune-inflammation value (PIV) compared with ALBI and MELD-Na scores in patients with HCC.

METHODS

This retrospective cohort study included 97 patients diagnosed with HCC and treated at the Medical Oncology Department of Ankara Etlik City Hospital between September 2022 and September 2025. Overall survival (OS) was analyzed using Kaplan-Meier survival analysis, Cox regression models, and receiver operating characteristic (ROC) curve analysis. Univariate and multivariable Cox regression analyses were performed to identify independent prognostic factors, and optimal cut-off values were determined using the Youden index.

RESULTS

Median follow-up was 10 months, and 58 deaths occurred. In univariate analysis, Eastern Cooperative Oncology Group (ECOG) performance status, Barcelona clinic liver cancer stage, cirrhosis, treatment modality, ALBI, MELD-Na score, and PIV were significantly associated with OS (all P < 0.05). In multivariable Cox regression analysis, ECOG performance status (P < 0.001) and PIV (P = 0.016) remained independent prognostic factors. ROC analysis demonstrated that PIV had the highest discriminatory ability for predicting OS (AUC = 0.794, P < 0.001), followed by ALBI (AUC = 0.781, P < 0.001), alpha-fetoprotein (AUC = 0.712, P < 0.001), and MELD-Na (AUC = 0.699, P = 0.001). Patients with high PIV had significantly poorer survival, with a median OS of 5 months compared with 30 months in the low-PIV group.

CONCLUSION

These findings demonstrate that PIV provides superior prognostic performance compared with conventional liver function-based scores and may serve as a robust biomarker for risk stratification in patients with HCC.

Keywords: Hepatocellular carcinoma; Pan-immune-inflammation value; Systemic inflammation; Prognostic biomarkers; Albumin-bilirubin score; Model for end-stage liver disease-sodium score; Survival; Prognosis

Core Tip: Pan-immune-inflammation value (PIV) is a novel biomarker reflecting systemic inflammatory and immune status in hepatocellular carcinoma (HCC). In this retrospective study, PIV demonstrated superior prognostic performance compared with conventional liver function scores such as albumin-bilirubin and model for end-stage liver disease-sodium and remained an independent predictor of overall survival. These findings suggest that inflammation-based indices may improve risk stratification beyond traditional liver function-based models in patients with HCC.