(1) Background: The reasons for changes in the inflammatory markers of patients with surgically resected hepatocellular carcinoma are unclear. We aimed to investigate the association of an inflammatory status with the prognosis of patients with hepatocellular carcinoma, who underwent surgical resection. (2) Methods: We retrospectively enrolled 91 patients with Child A hepatocellular carcinoma, who had received surgical resection, to explore the influence of preoperative inflammatory markers and postoperative changes on the prognosis. (3) Results: The platelet-to-lymphocyte ratio (PLR) and its alteration were independent prognostic factors. Patients with a low PLR had a significantly better recurrence-free survival (RFS) than those with a high PLR (1-year RFS of 88.5% versus 50.0%; 3-year RFS of 62.1% versus 25.0%, p = 0.038). The patients with a low PLR showed a significantly better overall survival (OS) than those with a high PLR (1-year OS of 98.9% versus 75.0%; 3-year OS of 78.2% versus 25.0%, p = 0.005). The patients whose PLR had increased at 6 months after operation showed a worse OS than patients whose PLR had decreased (1-year OS of 96.3% versus 98.4%; 3-year OS of 63.0% versus 79.7%, p = 0.048). However, neither the neutrophil-to-lymphocyte ratio nor Onodera’s prognostic nutritional index had any prognostic significance. (4) Conclusions: The PLR and its alteration are significant prognostic factors for the RFS and OS of patients with Child A hepatocellular carcinoma who had received curative surgery.

Introduction: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world. The overall prognosis of patients with HCC is not very ideal. Early detection of HCC has become one of the important means to reduce mortality. More and more studies have pointed out that inflammatory markers based on hematology, such as Onodera’s prognostic nutritional index (OPNI), have important clinical significance. However, there is a lack of relevant research on the diagnosis of HCC by inflammatory markers. Methods: We retrospectively enrolled 633 patients and prospectively recruited 121 consecutive patients, to explore the correlation between inflammatory markers and diagnosis of HCC. Based on the prognostic indicators, different diagnostic models were constructed and the diagnostic performance of different models was further compared. Results: The best cutoff value of OPNI in the diagnosis of HCC is 43.925. Area under the receiver operating characteristics curve (AUC) of gender + age + AFP + OPNI diagnosis of HCC is 0.837 (95% CI: 0.702–0.868) in the retrospective cohort. Compared with gender + age + AFP, the Nagelkerke R2 of gender + age + AFP + OPNI increased from 0.234 to 0.426, and AUC increased by 0.0973 (95% CI: 0.0659–0.1290). DeLong test, net reclassification improvement (NRI) test, and integrated discrimination improvement (IDI) test are all statistically significant. In the prospective cohort, AUC of gender + age + AFP + OPNI diagnosis of HCC is 0.782 (95% CI: 0.696–0.869). Compared with gender + age + AFP, NRI test is statistically significant (categorical 0.0909 [95% CI: 0.0060–0.1759], p = 0.0359). Conclusion: In the process of monitoring the occurrence of HCC in patients with risk factors, OPNI can be included as appropriate to improve the accuracy of HCC diagnosis.