Prognostic Factors for Post-recurrent Survival in Hepatocellular Carcinoma After Curative Resection

Background/Aim: Treatment algorithms for primary and recurrent hepatocellular carcinoma (HCC) are described in the current Japanese Clinical Practice Guidelines; however, primary and recurrent tumors exhibit several differences in oncological characteristics such as clinicopathological features and prognostic factors. This study aimed to investigate the prognostic factors for recurrent HCC including time of recurrence after primary hepatectomy, to elucidate appropriate treatment strategies in these patients. Patients and Methods: One hundred and nine patients who had undergone radical resection of primary HCC at our Hospital and had experienced intrahepatic recurrence were included in this study. Patients were categorized into the early-recurrence (ER, <1 year postoperatively) or the late-recurrence (LR, >= 1 year postoperatively) groups. Clinicopathological features were compared between the two groups for prognostic analyses. Results: Comparison of clinicopathological features between the ER and LR groups revealed that, at the time of recurrence, the ER group had a significantly higher frequency of multiple recurrences compared to the LR group. In univariate prognostic analysis, the time of recurrence (ER or LR) and the number of recurrent tumors (>= 3) were significant prognostic factors after recurrence. Multivariate analysis revealed that three or more recurrent tumors and ER were independent prognostic factors for poor survival after recurrence. Conclusion: HCC is likely to recur, and the characteristics of recurrent HCC are distinct from those of primary HCC. To improve post-recurrence poor prognosis, new and more feasible algorithms, such as aggressive surgical treatment for cases with less than three recurrent tumors, which were revealed in the current study, are needed.