Prognostic significance of early and multiple recurrences after curative resection for hepatocellular carcinoma

Purpose: In hepatocellular carcinoma (HCC), postoperative recurrence remains high. This study aimed to evaluate the recurrence patterns and prognosis of HCC after curative hepatectomy. Methods: : Among 339 patients with primary HCC who underwent initial hepatectomy between January 2000 and December 2021, 122 with recurrence were assessed for the relationship between recurrence pattern and prognosis. Results: : The early recurrence group (within 6 months postoperatively; n=28) had significantly higher serum alpha-fetoprotein (p=0.002) and des-𝛾-carboxyprothrombin (p=0.003) levels, larger tumor size (p<0.001), higher incidence of multiple tumors (p=0.016) and portal vein tumor thrombus (PVTT; p<0.001) and lower overall survival (OS) (p 6 months postoperatively; n=94). The multiple recurrence group (intrahepatic multinodular recurrence or distant metastasis; n=94) had significantly higher prognostic nutritional index (p=0.04), larger tumor size (p=0.021), higher incidence of PVTT (p=0.035), and lower incidence of well-differentiated tumor (p<0.001) and liver cirrhosis (p<0.001) than the single recurrence group (single nodule recurrence; n=47). The multiple recurrence group, especially patients with ≥three intrahepatic nodules and distant metastases (p<0.001, p<0.001), had lower postoperative OS and shorter time to recurrence than the single recurrence group. Conclusion: Early and multiple or distant tumor recurrences are poor prognostic factors after curative resection for HCC.