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Meng-Xin Tian,1,2,* Liu-Ping Luo,3,4,* Wei-Ren Liu,1,2,* Wei Deng,5 Jia-Cheng Yin,1,2 Lei Jin,1,2 Xi-Fei Jiang,1,2 Yu-Fu Zhou,1,2 Wei-Feng Qu,1,2 Zheng Tang,1,2 Han Wang,1,2 Chen-Yang Tao,1,2 Yuan Fang,1,2 Shuang-Jian Qiu,1,2 Jian Zhou,1–2,6 Jing-Feng Liu,3,4 Jia Fan,1–2,6 Ying-Hong Shi1,21Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, People’s Republic of China; 3Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 4The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 5Department of Health Statistics and Social Medicine, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, People‘s Republic of China; 6Institutes of Biomedical Sciences, Fudan University, Shanghai, People‘s Republic of China*These authors contributed equally to this work Purpose: To develop and validate a decision aid to help make individualized estimates of tumor recurrence for patients with resected combined hepatocellular cholangiocarcinoma (CHC).Patients and methods: Risk factors of recurrence were identified in the derivation cohort of 208 patients who underwent liver resection between 1995 and 2014 at Zhongshan Hospital to develop a prediction score. The model was subsequently validated in an external cohort of 101 CHC patients using the C concordance statistic and net reclassification index (NRI).Results: On multivariate analysis, five independent predictors associated with tumor recurrence were identified, including sex, γ-glutamyl transferase, macrovascular invasion, hilar lymphoid metastasis and adjuvant transcatheter arterial chemoembolization. The prediction score was constructed using these 5 variables, with scores ranging from 0 to 5. A patient with a score of 0 had a predicted 1- and 5-year recurrence risk of 11.1% and 22.2%, respectively. In the validation cohort, the NRIs of prediction score vs American Joint Committee on Cancer 7th, TNM staging system at 1-year and 5-year were 0.185 (95% CI, 0.090–0.279, P