Objective: To investigate the influence of liver function damage in patients with hepatocellular carcinoma (HCC) after microwave ablation (MWA) on the prognosis and to establish an algorithm to predict liver function damage. Methods: This is a retrospective study. A total of 745 patients were enrolled and classified into the modeling group and the validation group. The risk factors of liver function damage were analyzed by using logistic regression model. The β coefficients derived from a

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... ic analysis were used to calculate the risk score. Diagnostic accuracy based on risk score was assessed by the area under the curve (AUC). Results: 69 patients in the modeling group suffered from liver function damage. The 1-,3-,5-and 7-year progression free survival were 69.4%, 37.2%, 22.6% and 12.4% for patients without liver function damage and 69.5%, 33.0%, 14.4% and 0% for patients with liver function damage, respectively (P = 0.537). The 1-, 3-, 5-and 7-year overall survival were 94.3%, 75.9%, 61.5% and 54.5% for patients without liver function damage and 81.3%, 57.1%, 42.7% and 42.7% for those with liver function damage (P = 0.004), respectively. The AUC of the risk score for predicting liver function damage was 0.798 for the modeling group and 0.832 for the validation group. The sensitivity and specificity of the risk score to identify liver function damage was 65.2%, 84.4% in the modeling group and 60.6%, 88.3% in the validation group, respectively. Conclusion: Liver function damage after MWA is unfavorable the long-term prognosis. The prediction algorithm based on five risk factors is robust and can be used to predict possible liver function damage.