Abstract: Objective To investigate the effect of preoperative serum prealbumin（PA） on the prognosis of patients with alpha-fetoprotein-negative hepatocellular carcinoma（AFP-NHCC）. Methods A retrospective cohort study method was performed to collect 118 AFP-NHCC patients from Guangxi Medical University Cancer Hospital from January 2014 to December 2015. According to the preoperative serum PA content demarcation value，118 AFP-NHCC patienbs were divided into low PA group（<170 mg/L） and high PA group（≥170 mg/L）. Cox regression analysis was used to analyze the relationship between preoperative serum PA level and prognosis of patients with AFP-NHCC. Results Preoperative serum PA levels were associated with tumor diameter，macrovascular invasion，Child-Pugh classification，and BCLC stage（P<0.05）. Kaplan-Meier survival analysis showed that the median survival time was lower in the low PA group than that in the high PA group（24.5 months vs 36.0 months， χ²=11.689，P=0.001）. Cox regression analysis showed that patients with AFP-NHCC in the low PA group had a higher risk of death than those in the high PA group（HR=2.779，95%CI：1.406-5.492，P=0.003）， and this relationship persisted after controlling for potential confounders. Conclusion Preoperative serum low PA levels are associated with poor prognosis in patients with AFP-NHCC and can be used as an indicator of prognosis.

Key words: Hepatocellular carcinoma, Hepatectomy, Prealbumin, Alpha-fetoprotein, Prognosis