Abstract: Objective To investigate the risk factors for recurrence after liver transplantation in patients with hepatitis B virus (HBV) infection-related hepatocellular carcinoma (HCC), and to further construct a predictive model. Methods The clinical data of 106 patients with HCC undergoing liver transplantation in the First Affiliated Hospital of Hebei North University from January 2015 to May 2020 were retrospec-tively analyzed. The χ ² test was used to analyze the factors influencing HCC recurrence, and multivariate logistic regression was used to analyze the influencing factors of HCC recurrence. According to the selected risk factors, the predictive model of HCC recurrence was constructed, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive model. Results Of the 106 HCC patients, 23 had recurrence, with a recurrence rate of 21.70%, and 20 died. Tumor differentiation (χ ²=6.066, P=0.014), maximum tumor diameter (χ ²=4.916, P=0.027), with or without envelope invasion (χ ²=5.543, P=0.019), preoperative alpha fetoprotein (AFP) (χ ²=5.458, P=0.019), HBV-DNA (χ ²=5.446, P=0.020), neutrophil lymphocyte ratio (NLR) (χ ²=12.161, P<0.001), the expressions of miR-424 (χ ²=4.400, P=0.036), chromodomain helicase DNA-binding protein 8 (CHD8) (χ ²=10.561, P=0.001), T-cadherin (T-cad) (χ ²=48.723, P<0.001), laminin (LN) (χ ²=18.506, P<0.001) and hepatocyte growth factor (HGF) (χ ²=11.178, P=0.001) were related to the recurrence of HCC. Multivariate logistic regression analysis showed that the maximum tumor diameter≥6.5 cm (OR=1.69, 95%CI: 1.25-3.17, P=0.002), preoperative AFP>400 ng/ml (OR=1.38, 95%CI: 1.09-1.92, P=0.038), positive CHD8 (OR=0.77, 95%CI: 0.52-0.89, P=0.021), positive T-cad (OR=0.84, 95%CI: 0.68-0.92, P=0.006), positive LN (OR=1.22, 95%CI: 1.03-1.50, P=0.013) were the risk factors of HCC recurrence. According to the results of logistic analysis, the regression equation logit(P)=0.262+0.523X₁+0.326X₂-0.259X₃-0.286X₄+0.203X₅ was constructed, where X₁, X₂, X₃, X₄, X₅ were the maximum tumor diameter, AFP, CHD8, T-cad and LN. ROC curve analysis showed that the area under the curve for predicting HCC recurrence was 0.849 (95%CI: 0.763-0.894, P<0.001), the accuracy rate was 83.02%, the sensitivity was 86.96%, the specificity was 81.93%, and the cut-off value was 0.736. According to the logit(P) function model, P=1/(1+e ^{- Y}), where Y=0.262+0.523X₁+0.326X₂-0.259X₃-0.286X₄+0.203X₅. One patient was randomly selected. According to his clinical data, P=0.564, which was less than the cut-off value (0.736). It could be considered that this patient would not have HCC recurrence with an accuracy rate of 83.02%. Conclusion Tumor maximum diameter, preoperative AFP, CHD8, T-cad, LN expression are related to the recurrence of HCC after liver transplantation. The prediction model constructed based on this can effectively predict the risk of HCC recurrence.

Key words: Carcinoma, hepatocellular, Liver transplantation, Alpha-fetoprotein, Tumor diameter