A three-factor preoperative scoring model predicts risk of recurrence after liver resection or transplantation in hepatocellular carcinoma patients with preserved liver function

BACKGROUND: No staging systems of hepatocellular carcinoma(HCC) are tailored for assessing recurrence risk. We sought to establish a recurrence risk scoring system to predict recurrence of HCC patients receiving surgical curative treatment(liver resection or transplantation).METHODS: We retrospectively studied 286 HCC patients with preserved liver function receiving liver resection(n=184) or transplantation(n=102). Independent risk factors were identified to construct the recurrence risk scoring model. The recurrence free survival and discriminatory ability of the model were analyzed. RESULTS: Total tumor volume, HBs Ag status, plasma fibrinogen level were included as independent prognostic factors for recurrence-free survival and used for constructing a 3-factor recurrence risk scoring model. The scoring model was as follows: 0.758×HBs Ag status(negative: 0; positive: 1)+0.387×plasma fibrinogen level(≤3.24 g/L: 0; >3.24 g/L: 1)+0.633×total tumor volume(≤107.5 cm3: 0; >107.5 cm3: 1). The cutoff value was set to 1.02, and we defined the patients with the score ≤1.02 as a low risk group and those with the score >1.02 as a high risk group. The 3-year recurrence-free survival rate was significantly higher in the low risk group compared with that in the high risk group(67.9% vs 41.3%, P<0.001). In the subgroup analysis, liver transplantation patients had a better3-year recurrence-free survival rate than the liver resection patients in the low risk group(80.0% vs 64.0%, P<0.01). Additionally for patients underwent liver transplantation, we compared the recurrence risk model with the Milan criteria in the prediction of recurrence, and the 3-year recurrence survival rates were similar(80.0% vs 79.3%, P=0.906).CONCLUSION: Our recurrence risk scoring model is effective in categorizing recurrence risks and in predicting recurrencefree survival of HCC before potential surgical curative treatment.