Abstract: Abstract: Objective　To compare the predictive ability of up-to-7 criteria and Milan criteria in the prognosis of patients with multifocal hepatocellular carcinoma (HCC) after liver resection. Methods　The clinicopathological data of 252 patients with multifocal HCC treated with hepatectomy were collected. Overall survival (OS) and disease-free survival (DFS) were estimated by Kaplan-Meier method, and Log-rank test was used to compare the differences in survival between the meeting group and the exceeding group under the two criteria. Multivariate Cox regression analysis was used to determine independent risk factors affecting OS and DFS. The accuracy in predicting OS and DFS was evaluated using t-ROC curve analysis and the area under ROC curve (AUC). Results　There were no significant differences in OS and DFS between the Milan criteria meeting group (n=36) and the exceeding group (n=216). However, the OS and DFS were significantly higher in the up-to-7 criteria meeting group (n=92) than those in the up-to-7 criteria exceeding group (n=160). Multivariate Cox analyses determined that age ≥60 years (HR =1.649, 95%CI: 1.079-2.520), AFP≥400 μg/L (HR=1.521, 95%CI: 1.046-2.212) and exceeding up-to-7 criteria (HR=1.510, 95%CI: 1.013-2.249) were independent risk factors for OS in patients with multifocal HCC after liver resection (all P＜0.05). The higher AST level (HR=1.004, 95%CI: 1.001-1.007) and exceeding up-to-7 criteria (HR =2.102, 95%CI: 1.499-2.948) were independent risk factors for DFS in patients with multifocal HCC after liver resection (P＜0.05). ROC curve analyses showed that both the AUCs of up-to-7 criteria predicting OS and DFS were greater than those of Milan criteria. Conclusion　The Up-to-7 criteria is superior to Milan criteria in predicting the prognosis of patients with multifocal HCC after liver resection.

Key words: hepatocellular carcinoma, liver resection, prognosis, up-to-7 criteria, Milan criteria