A simple model to predict early recurrence of hepatocellular carcinoma after liver resection

Abstract Purpose: Multiple studies have reported models for predicting early recurrence of hepatocellular carcinoma (HCC) after liver resection (LR). However, these models are too complex to use in daily practice. We aimed to develop a simple model. Method: We enrolled 1133 patients with newly diagnosed HCC undergoing LR. The Kaplan−Meier method and log-rank test were used for survival analysis and Cox proportional hazards analysis to identify prognostic factors associated with early recurrence (i.e., recurrence within two years after LR). Results: Early recurrence was identified in 403 (35.1%) patients. In multivariate analysis, alpha-fetoprotein (AFP) 20–399 vs <20 ng/ml (HR=1.282 [95% confidence interval=1.002–1.639]; p=0.048); AFP ≥ 400 vs <20 ng/ml (HR=1.755 [1.382–2.229]; p<0.001); 7th edition American Joint Committee on Cancer (AJCC) stage 2 vs 1 (HR=1.958 [1.505–2.547]; p<0.001); AJCC stage 3 vs 1 (HR=4.099 [3.043–5.520]; p<0.001); and pathology-defined cirrhosis (HR=1.46 [1.200–1.775]; p<0.001) were associated with early recurrence. We constructed a predictive model with these variables, which provided three risk strata for recurrence-free survival (RFS): low risk, intermediate risk, and high risk, with two-year RFS of 79%, 57%, and 35%, respectively (p<0.001). Conclusion: We developed a simple model to predict early recurrence risk for patients undergoing LR for HCC.