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; Chao Li; Lan-Qing Yao; Hai-Bo Qiu; Ming-Da Wang; Xin-Fei Xu; Ya-Hao Zhou; Hong Wang; Ting-Hao Chen; Wei-Min Gu; Jian-Hong Zhong; Han Wu; Timothy M Pawlik; Wan Yee Lau; Feng Shen; Tian Yang

doi:10.21037/hbsn-21-288

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

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

Authors

Wen-Tao Yan^#^{1

2}, Chao Li^#¹, Lan-Qing Yao^#¹, Hai-Bo Qiu^#³, Ming-Da Wang¹, Xin-Fei Xu¹, Ya-Hao Zhou⁴, Hong Wang⁵, Ting-Hao Chen⁶, Wei-Min Gu⁷, Jian-Hong Zhong⁸, Han Wu¹, Timothy M Pawlik⁹, Wan Yee Lau^{1

10}, Feng Shen¹, Tian Yang¹

Affiliations

¹ Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China.
² Graduate School, Second Military Medical University (Navy Medical University), Shanghai, China.
³ Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China.
⁴ Department of Hepatobiliary Surgery, Pu'er People's Hospital, Pu'er, China.
⁵ Department of General Surgery, Liuyang People's Hospital, Liuyang, China.
⁶ Department of General Surgery, Ziyang First People's Hospital, Ziyang, China.
⁷ The First Department of General Surgery, the Fourth Hospital of Harbin, Harbin, China.
⁸ Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.
⁹ Department of Surgery, Ohio State University, Wexner Medical Center, Columbus, OH, USA.
¹⁰ Faculty of Medicine, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.

^# Contributed equally.

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.