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. 2023 Apr 10;12(2):155-168.
doi: 10.21037/hbsn-21-288. Epub 2021 Oct 21.

Predictors and long-term prognosis of early and late recurrence for patients undergoing hepatic resection of hepatocellular carcinoma: a large-scale multicenter study

Wen-Tao Yan #  1   2 , Chao Li #  1 , Lan-Qing Yao #  1 , Hai-Bo Qiu #  3 , Ming-Da Wang  1 , Xin-Fei Xu  1 , Ya-Hao Zhou  4 , Hong Wang  5 , Ting-Hao Chen  6 , Wei-Min Gu  7 , Jian-Hong Zhong  8 , Han Wu  1 , Timothy M Pawlik  9 , Wan Yee Lau  1   10 , Feng Shen  1 , Tian Yang  1
Affiliations

Predictors and long-term prognosis of early and late recurrence for patients undergoing hepatic resection of hepatocellular carcinoma: a large-scale multicenter study

Wen-Tao Yan et al. Hepatobiliary Surg Nutr. .

Abstract

Background: Recurrence is common among patients undergoing hepatic resection for hepatocellular carcinoma (HCC), which greatly limits long-term survival. We aimed to identify predictors and long-term prognosis of early and late recurrence after HCC resection.

Methods: Multicenter data of patients who underwent HCC resection between 2002 and 2016 were analyzed. Recurrence was divided into early (≤2 years) and late recurrence (>2 years after surgery). Predictors of early and late recurrence, and prognostic factors of post-recurrence survival (PRS) were identified by univariate and multivariate analyses.

Results: Among 1,426 patients, 554 (38.8%) and 348 (24.4%) developed early and late recurrence, respectively. Independent predictors associated with early recurrence included preoperative alpha-fetoprotein level >400 µg/L, resection margin <1 cm, and tumor size >5.0 cm, multiplicity, macrovascular and microvascular invasion, and satellites of the initial tumor at the first diagnosis of HCC; independent predictors associated with late recurrence included male, cirrhosis, and tumor size >5.0 cm, multiplicity, macrovascular and microvascular invasion, and satellites of the initial tumor. Patients with early recurrence had a lower likelihood of undergoing potentially curative treatments for recurrence (37.2% vs. 48.0%, P<0.001) and a worse median PRS (13.5 vs. 36.6 months, P<0.001) vs. patients who had late recurrence. Multivariate analysis revealed that early recurrence and irregular postoperative surveillance were independently associated with worse PRS [hazard ratio (HR) =1.250, 95% CI: 1.016-1.538, P=0.035; and HR =1.983, 95% CI: 1.677-2.345, P<0.001].

Conclusions: Predictors associated with early and late recurrence after curative resection for patients with HCC were generally same, although several did differ. Patients with late recurrence had better long-term survival than patients with early recurrence.

Keywords: Hepatocellular carcinoma (HCC); hepatectomy; predictor; prognosis; recurrence.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-21-288/coif). WYL and TMP serve as the unpaid editorial board members of Hepatobiliary Surgery and Nutrition. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier analysis of overall survival in patients without recurrence, patients with early recurrence and with late recurrence after curative liver resection of hepatocellular carcinoma. P<0.001 (without recurrence vs. early recurrence), P<0.001 (without recurrence vs. late recurrence), and P<0.001 (early recurrence vs. late recurrence) (log-rank test).
Figure 2
Figure 2
Kaplan-Meier analysis of post-recurrence survival between patients with early and late recurrence (A) (P<0.001, log-rank test), and between patients with recurrence who underwent regular and irregular recurrence surveillance (B) (P=0.002, log-rank test).
Figure 3
Figure 3
Risk factors with statistical significance in multivariate Cox-regression analyses predicting early and late recurrence in patients who underwent curative hepatic resection of hepatocellular carcinoma.
See this image and copyright information in PMC

Comment in

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