Background: Preoperative inflammatory and nutrition-related markers—including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), prognostic nutritional index (PNI), and controlling nutritional status (CONUT) score—have shown prognostic relevance in various malignancies. However, their comparative utility in predicting recurrence and survival across clinically relevant subgroups in patients with intrahepatic cholangiocarcinoma (iCCA) undergoing curative-intent resection remains unclear. Methods: This retrospective study included 213 patients with histologically confirmed iCCA who underwent curative-intent resection between 2015 and 2021. Preoperative NLR, LMR, PNI, and CONUT scores were calculated from laboratory data obtained within one week before resection. Clinicopathological variables, recurrence, and survival outcomes were analyzed using Cox regression and Kaplan–Meier methods. Results: A preoperative NLR ≥ 2.4 was independently associated with poorer DFS (HR = 1.66, p = 0.025) and OS (HR = 1.94, p = 0.006). This effect remained significant in patients with R0 resection (DFS: HR = 1.66, p = 0.004; OS: HR = 2.11, p = 0.014) and in those who subsequently developed recurrence (OS: HR = 1.83, p = 0.004). The CONUT score was correlated with OS in both R0 and recurrent subgroups. Tumor morphology, consistent with prior reports, was identified as a postoperative pathological factor associated with worse prognosis. Conclusions: Preoperative NLR was associated with poorer DFS and OS in iCCA patients undergoing curative-intent resection. This association was consistently observed in subgroups with R0 resection and in those who developed recurrence. Meanwhile, the CONUT score showed limited independent significance only among patients with R0 resection who experienced recurrence.

Background: Hepatocellular carcinoma (HCC) remains a major contributor to global cancer mortality. Increasing evidence suggests that the gut microbiota is a key modulator of liver disease progression and a promising source of non-invasive biomarkers. However, regional disparities in microbial profiles, influenced by ethnicity, diet, and environment, limit the generalizability of the existing data. This study aimed to characterize gut microbiota alterations in Thai patients with advanced untreated HCC compared to healthy individuals. Method: Fecal samples from 27 untreated Thai advanced HCC patients were collected, and data from 31 healthy individuals retrieved from a previous study were employed. Gut microbiota profiles were analyzed using 16S rRNA gene sequencing. Results: Alpha diversity was significantly reduced in HCC patients (p < 0.001). At the phylum level, Proteobacteria and Firmicutes were enriched in HCC, whereas Actinobacteria were more abundant in controls. Proteobacteria and Bacteroidota levels were positively correlated with serum alpha-fetoprotein (AFP) levels, whereas Firmicutes were negatively correlated with ALBI scores. Conclusions: Thai patients with advanced HCC exhibited distinct gut microbial signatures, characterized by dysbiosis and expansion of Proteobacteria. These findings support the role of the gut microbiota as a potential non-invasive biomarker for disease severity and prognosis in HCC, underscoring the importance of population-specific microbial studies.