Abstract: Objective To evaluate the prognostic value of tumor burden score（TBS） in patients with hepatocellular carcinoma（HCC）. Methods The clinical data of 487 patients with HCC undergoing liver resection were retrospectively collected. Time-dependent ROC analysis was conducted to evaluate the ability of TBS in predicting overall survival（OS） and disease-free survival （DFS）. Multivariable Cox regression analysis was used to determine independent factors affecting prognosis. Results Time-dependent ROC analysis showed that the AUC of TBS for predicting OS at 5 years was 0.722，higher than that of maximum tumor diameter （0.711） and tumor number（0.548）. TBS stratified patients into 4 prognostic risk strata，namely TBS ≤3 （n=70，14.4%），3n=175，35.9%），5n=150，30.8%），and TBS>8（n=92，18.9%）. The 5-year OS for patients in the 4 risk strata was 87.5%，75.7%，62.9%，and 36.3%，respectively（P<0.001）. The 5-year DFS in the 4 risk strata was 62.4%，44.2%，31.1%，and 12.9%，respectively（P<0.001）. Multivariable analysis also revealed that TBS was an independent factor for both OS and DFS in patients with HCC after liver resection. Conclusion TBS may be a good tool for predicting the prognosis of patients with HCC after liver resection.

Key words: Hepatocellular carcinoma, Tumor burden score, Liver resection, Prognosis