Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Sep 18;409(1):283.
doi: 10.1007/s00423-024-03474-x.

Preoperative predictors of very early recurrence in patients with hepatocellular carcinoma beyond the Milan criteria

Satoshi Yasuda  1 , Yasuko Matsuo  2 , Shunsuke Doi  2 , Takeshi Sakata  2 , Minako Nagai  2 , Kota Nakamura  2 , Taichi Terai  2 , Yuichiro Kohara  2 , Masayuki Sho  2
Affiliations

Preoperative predictors of very early recurrence in patients with hepatocellular carcinoma beyond the Milan criteria

Satoshi Yasuda et al. Langenbecks Arch Surg. .

Abstract

Purpose: Hepatocellular carcinoma (HCC) patients beyond the Milan criteria (MC) who undergo liver resection have high recurrence rates and poor prognosis, and sometimes experience very early recurrence (VER) within six months after surgery. This study aimed to identify predictive factors, including the newly proposed C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index, for VER after surgery for HCC beyond MC.

Methods: We included patients who underwent initial liver resection for HCC beyond MC between 2000 and 2021. We defined VER as recurrence within six months after surgery and compared the clinicopathological factors and long-term prognosis between the VER and non-VER groups. Multivariate analysis identified risk factors for VER and evaluated the potential for prognostic stratification using these factors.

Results: The overall survival (OS) and post-recurrence survival were significantly worse in the VER group compared to patients with recurrence in 7-12 months, over 12 months, and without recurrence (median survival time (MST) 1.16 vs. 5.14, 7.26, and undefined; and MST 0.81 vs. 4.34, and 5.48, respectively, P < 0.01). Alpha-fetoprotein (AFP) ≥ 200, non-simple nodule (SN) type on preoperative imaging, and CALLY index < 2.8 were independent prognostic factors (P < 0.01 for all). An increased risk factor count was correlated with poorer VER and OS rates, allowing for effective stratification.

Conclusion: VER after hepatic resection for HCC beyond MC was associated with a significantly poorer prognosis. AFP, non-SN type on imaging, and CALLY index are valuable preoperative indicators. Patients with multiple risk factors have a worse prognosis and may be candidates for multimodal treatment.

Keywords: Beyond Milan criteria; CALLY index; Hepatocellular carcinoma; Very early recurrence.

PubMed Disclaimer

References

    1. McGlynn KA, Petrick JL, El-Serag HB (2021) Epidemiology of hepatocellular carcinoma. Hepatology 73(Suppl 1):4–13. https://doi.org/10.1002/hep.31288 - DOI - PubMed
    1. Kulik L, El-Serag HB (2019) Epidemiology and management of hepatocellular carcinoma. Gastroenterology 156:477–491. https://doi.org/10.1053/j.gastro.2018.08.065 - DOI - PubMed
    1. Hasegawa K, Takemura N, Yamashita T, Watadani T, Kaibori M et al (2023) Clinical practice guidelines for hepatocellular carcinoma: the Japan Society of Hepatology 2021 version (5th JSH-HCC guidelines). Hepatol Res 53:383–390. https://doi.org/10.1111/hepr.13892 - DOI - PubMed
    1. European Association for the Study of the Liver (2018) Electronic address eee, European association for the study of the L. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 69:182–236. https://doi.org/10.1016/j.jhep.2018.03.019 - DOI
    1. Zhou J, Sun H, Wang Z, Cong W, Zeng M et al (2023) Guidelines for the diagnosis and treatment of primary liver cancer (2022 Edition). Liver cancer 12:405–444. https://doi.org/10.1159/000530495 - DOI - PubMed - PMC

MeSH terms

Substances

LinkOut - more resources