Predictors for early recurrence beyond up-to-7 or distant metastasis after hepatocellular carcinoma resection: Proposal for borderline resectable HCC

Abstract Background The recurrence rate after curative resection for hepatocellular carcinoma (HCC) reaches over 70% after 5 years. Furthermore, early HCC recurrence (within 1 year) is now recognized as having a poor prognosis and has limited treatment options. Methods We retrospectively reviewed 184 consecutive patients who underwent curative hepatic resection for HCC in our institute. Severe early recurrence was defined as multiple (beyond up-to-7) liver recurrence or distant metastasis after hepatic resection within 1 year. We divided the participants into two groups according to severe early recurrence and analyzed clinicopathological and long-term outcomes. Results Among the patients with hepatic multiple, up-to-7 out, and distant metastasis (n = 59), 49 patients (83%) had recurrence within 1 year. Overall survival (OS) and recurrence-free survival (RFS) were significantly worse in the severe early recurrence group than in the others group. Logistic regression analysis revealed that severe early recurrence was significantly associated with macroscopic vascular invasion (MVI), tumor burden score (TBS) > 4.70 and ALBI grade 2. In patients with a score of 2 and 3 (the sum of the three factors in the multivariate analysis (MVI, TBS > 4.70 and ALBI grade 2)), OS and RFS rates were significantly poorer than those of patients with a score of 0 or 1. Positive predict value and negative predict value for severe early recurrence was 68.4% and 84.2%, respectively. Conclusions In this retrospective analysis, we found that MVI, TBS and ALBI could predict severe early recurrence after hepatic resection for HCC, and patients with these risk factors had a poor prognosis.