The Predictive Model for Recurrence After Hepatectomy in Hepatocellular Carcinoma Patients Based on the Tumor Burden Score Combined with the Prognostic Nutritional Index and Other Indicators

Abstract Objective: This study aimed to investigate the influence of the tumor burden score (TBS), prognostic nutritional index (PNI), prothrombin time (PT), and preoperative extrahepatic metastasis on the risk of postoperative recurrence in patients with hepatocellular carcinoma (HCC) undergoing hepatectomy. A simplified prognostic model, termed the PNTR scoring system, was developed and subsequently validated to assess recurrence risk. Methods:This retrospective study included 301 patients with hepatocellular carcinoma (HCC) from three medical centers, with data collected between 2015 and 2023. The PNTR scoring system was utilized to predict recurrence-free survival (RFS) in both the derivation cohort (n=232) and the validation cohort (n=69). Variables such as TBS, PNI, PT, and preoperative extrahepatic metastasis were evaluated for their association with postoperative recurrence. Subgroup analyses were conducted to assess recurrence patterns at various sites, including local tumor recurrence (LTR), intrahepatic distant recurrence (IDR), and extrahepatic recurrence (ER).Statistical analysis was performed using Cox proportional hazards regression models, and Kaplan-Meier survival curves were employed for subgroup comparisons. Results: A high TBS, prolonged PT, low PNI, and preoperative extrahepatic metastasis were identified as independent risk factors for recurrence. The PNTR scoring system demonstrated that higher scores were associated with an increased risk of recurrence. In both the derivation cohort and validation cohort, the model exhibited robust discriminatory ability, with the following area under the curve (AUC) values: at 6 months (AUC = 0.748 vs 0.692), at 1 year (AUC = 0.711 vs 0.676), and at 2 years (AUC = 0.775 vs 0.663). These findings indicate that the model effectively differentiates between recurrence patterns. Conclusion: The PNTR scoring system represents a precise and dependable instrument for predicting postoperative recurrence in patients with HCC, and it may aid in optimizing both monitoring protocols and therapeutic strategies.