肝癌切除术后复发率可能高达50-70％。虽然可以进行挽救性肝移植，但患者可能会出现不适宜移植的复发（超出米兰标准）。本研究旨在确定术前风险因素以预测切除后的不适宜移植复发。从一个多机构数据库中筛选出接受过肝癌根治性切除术的患者，并确定与不适宜移植复发有关的术前因素。开发和验证风险评分模型（NTR分数）。在1620例患者中，842例（52.0％）复发；在复发患者中，341例（40.5％）出现不适宜移植复发，复发自由生存中位数为30个月（24.7-35.3个月）。在多变量分析中，与不适宜移植复发有关的因素包括甲胎蛋白（AFP）> 400 ng / mL [风险比（HR）1.71，95％置信区间（CI）1.33-2.19]，白蛋白-胆红素评分（ALBI）（参考低，中度ALBI：HR 1.41，95％ CI 1.10-1.81，高ALBI：HR 2.47，95％ CI 0.91-6.68）和肿瘤负担得分（TBS）（参考低，高TBS：HR 2.55，95％CI，1.99-3.28）。利用每个因素的β系数开发了一个简化的TBS-based NTR分数（C指数为0.68，95％CI为0.65-0.71）。较高的NTR分数与逐渐恶化的5年复发生存率（低44.8％，中37.5％，高24.5％）[曲线下面积（AUC）0.59]以及NTR发生率增加（低13.7％，中25.4％，高38.2％）（AUC 0.65）（均p <0.001）有关。此外，较高的NTR分数与额外肝外复发的风险增加有关（低11.3％，中28.8％，高37.5％）（p <0.001）。肝癌切除术后的不适宜移植复发发生率为五分之一。一个简单的TBS-based NTR分数能够准确预测NTR风险，并有助于鉴别直接行手术还是建议移植的患者。©2023年。外科肿瘤学会。

Recurrence following liver resection (LR) for hepatocellular carcinoma (HCC) can be as high as 50-70%. While salvage liver transplantation may be feasible, patients may develop a non-transplantable recurrence (NTR) (recurrence beyond Milan criteria). We sought to identify preoperative risk factors to predict NTR after resection.Patients who underwent curative-intent LR for HCC were identified from a multi-institutional database. Preoperative factors associated with NTR were identified and a risk score model (NTR score) was developed and validated.Among 1620 patients, 842 (52.0%) developed recurrence; among patients with recurrence, NTR occurred in 341 (40.5%) with a median recurrence-free survival (RFS) of 30 months (24.7-35.3 months). On multivariable analysis, factors associated with NTR included alpha fetoprotein (AFP) > 400 ng/mL [hazard ratio (HR) 1.71, 95% confidence interval (CI) 1.33-2.19], albumin-bilirubin grade (ALBI) (referent low, medium ALBI: HR 1.41, 95% CI 1.10-1.81, high ALBI: HR 2.47, 95% CI 0.91-6.68), and tumor burden score (TBS) (referent low, high TBS: HR 2.55, 95% CI, 1.99-3.28). A simplified TBS-based NTR score was developed using the β-coefficients of each factor (C-index 0.68, 95% CI 0.65-0.71). Higher NTR score was associated with incrementally worse 5-year RFS (low 44.8%, medium 37.5%, high 24.5%) [area under the curve (AUC) 0.59] and increased incidence of NTR (low 13.7%, medium 25.4%, high 38.2%) (AUC 0.65) (both p < 0.001). Moreover, higher NTR score was associated with higher risk of extrahepatic recurrence (low 11.3%, medium 28.8%, high 37.5%) (p < 0.001).NTR following curative-intent resection of HCC occurred in one in five patients. A simple TBS-based NTR score accurately predicted the risk of NTR and may help identify candidates for upfront resection versus transplantation.© 2023. Society of Surgical Oncology.