Building a scoring model based on plasma fibrinogen concentration for predicting recurrence of hepatocellular carcinoma after liver transplantation

Background: We investigated the prognostic value of preoperative fibrinogen levels in hepatocellular carcinoma patients receiving liver transplantation by building a scoring model for predicting tumor recurrence. Methods: Cox regression analysis was used to identify factors that predicted tumor recurrence, and a scoring model was generated by assigning a value of 0 or 1 to each independent risk factor. The cut-off value for fibrinogen was determined by receiver operating characteristic curve analysis. Results: Preoperative fibrinogen concentration was significantly higher in patients with vs. without tumor recurrence (3.27 g/L vs. 2.34 g/L, P < 0.001), with vs. without macrovascular invasion (3.54 g/L vs. 2.82 g/L, P = 0.007), and with >400 vs. ≤400 ng/mL plasma alpha-fetoprotein concentration (3.43 g/L vs. 2.76 g/L, P = 0.007). The 5-year disease-free survival rate was significantly lower for patients with elevated (≥2.68 g/L) vs. normal (<2.68 g/L) fibrinogen concentration (37.2% vs. 78.4%, P = 0.001). Macrovascular invasion, >3 tumor nodules, and elevated fibrinogen concentration were independent risk factors for tumor recurrence. A scoring model based on these risk factors predicted recurrence with a sensitivity of 68.3% and a specificity of 87.5%. Conclusions: Elevated preoperative plasma fibrinogen concentration is associated with tumor recurrence in HCC patients after liver transplantation. A new scoring model predicted recurrence with good sensitivity and specificity. Keywords: Liver transplantation (LT), Hepatocellular carcinoma (HCC), Scoring model, Recurrence, Fibrinogen concentration