Clinical value of blood routine and tumor markers in differentiating hepatocellular carcinoma from intrahepatic cholangiocarcinoma

Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are the 2 major types of primary liver cancer, differing significantly in etiology, treatment strategies, and prognosis despite their common hepatic origin. Accurate preoperative differentiation between HCC and ICC is critical for optimizing treatment and improving patient outcomes. However, traditional diagnostic methods, including imaging and tumor markers, have limitations in sensitivity and specificity, necessitating the exploration of novel diagnostic approaches. This retrospective study included 165 patients diagnosed with HCC (n = 87) or ICC (n = 78) between January 2023 and January 2024. Preoperative data, including routine blood tests and tumor markers (e.g., alpha-fetoprotein [AFP], carbohydrate antigen 19-9 [CA19-9], carcinoembryonic antigen [CEA]), were collected. Blood routine parameters, such as white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR), were analyzed. Univariate and multivariate logistic regression analyses were conducted to identify independent diagnostic factors. A predictive model was constructed and its diagnostic performance evaluated using receiver operating characteristic curves. Subgroup analyses were performed to investigate diagnostic efficiency in different patient subsets. AFP and CA19-9 emerged as key tumor markers for differentiating HCC and ICC. AFP levels were significantly higher in HCC patients (P < .001), whereas CA19-9 levels were markedly elevated in ICC patients (P < .001). Among blood routine parameters, elevated WBC (P < .001), monocyte count (P = .005), NLR (P = .02), and monocyte ratio (P = .012) were associated with an increased risk of ICC, while a higher LMR was protective against ICC (P = .006). The multivariate logistic regression model demonstrated robust diagnostic accuracy, with an area under the curve (AUC) of 0.791. Subgroup analyses revealed superior diagnostic performance at higher levels of AFP (≥200 ng/mL, AUC = 0.90) and CA19-9 (≥37 U/mL, AUC = 0.91). The combination of blood routine parameters and tumor markers demonstrates high diagnostic efficacy in preoperatively differentiating HCC and ICC. Key markers, including AFP and CA19-9, along with inflammatory and immune-related blood parameters such as WBC, NLR, and LMR, significantly enhance diagnostic accuracy. This study provides valuable insights into refining diagnostic strategies and supports individualized treatment planning for patients with primary liver cancer.