To evaluate the predictive value of liver fibrosis indicator S index for the recurrence and survival of patients with liver cancer meeting Milan criteria complicated with chronic hepatitis B (CHB) after radical hepatectomy.

Clinical data of 287 patients with liver cancer meeting Milan criteria complicated with CHB who underwent radical hepatectomy in Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science & Technology from January 2013 to December 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 248 patients were male and 39 female, aged from 22 to 78 years, with a median age of 51 years. The optimal cut-off value of S index was determined by the receiver operating characteristic (ROC) curve. All patients were divided into two groups according to the optimal cut-off value. Survival analysis was performed by Kaplan-Meier method and Log-rank test. Cox's proportional hazards regression model was used for univariate and multivariate analyses of clinical prognosis.

The postoperative 1-, 3- and 5-year disease-free survival of patients with S index≤0.16 (low S index group) were 90.1%, 73.6% and 62.4%, and were 80.7%, 52.4% and 40.8% in patients with S index > 0.16 (high S index group). The postoperative 1-, 3- and 5-year overall survival in low S index group were 97.5%, 86.0% and 81.1%, and were 95.2%, 72.9% and 60.7% in high S index group. The postoperative disease-free survival and overall survival of patients with high S index after hepatectomy were significantly worse compared with those with low S index (HR=1.994, 2.687; P<0.05). Cox's multivariate analysis showed that S index > 0.16 was an independent risk factor for the postoperative tumor-free survival and overall survival of patients (HR=1.837, 2.309; P<0.05).

S index can serve asa reference parameter to predict the prognosis of patients with liver cancer meeting Milan criteria complicated with CHB. S index > 0.16 indicates high recurrence rate and poor clinical prognosis.