Abstract
BACKGROUND AND PURPOSE: Hepatocellular carcinoma (HCC) is associated with poor prognosis due to its high propensity for early postoperative recurrence. In this study, we aimed to develop a novel model based on changes in perioperative aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels to predict early recurrence following hepatectomy for HCC. METHODS: This study is a dual-center retrospective cohort study. Based on strict inclusion and exclusion criteria, 317 hepatocellular carcinoma (HCC) patients from Center 1 and 58 patients from Center 2 were enrolled. Patients from Center 1 were randomly allocated in a 7:3 ratio into a training set (n=221) and an internal validation set (n=96), while Center 2 served as an independent external validation set. In the training set, independent risk factors associated with early recurrence after hepatectomy for HCC were identified through univariate and multivariate analyses, and a predictive model was constructed. The predictive performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). Calibration curves and decision curve analysis (DCA) were employed to assess model calibration and clinical utility, respectively. Additionally, model interpretability was visualized through the SHapley Additive exPlanations (SHAP) framework. Based on the combined model's predictions, this study further stratified patients' two-year progression-free survival (PFS) and five-year overall survival (OS) using Kaplan-Meier curves. RESULTS: Univariate and multivariate analyses revealed that alpha-fetoprotein (AFP), total bilirubin (TB), postoperative ALT (ALTp), HBV infection history, tumor size, and change in AST and ALT (CAA) were independent risk factors for early recurrence (P<0.05). The predictive model incorporating these factors achieved an AUC of 0.804, demonstrating robust predictive capability. The model exhibited strong consistency between predicted outcomes and actual observations in the training, internal validation, and external validation sets. CONCLUSION: This retrospective cohort study successfully established a predictive model for early recurrence after hepatectomy in HCC patients, highlighting its potential clinical utility.