Early versus late recurrence of centrally located hepatocellular carcinoma after mesohepatectomy A cohort study based on the STROBE guidelines

The aim of this study was to investigate the features, treatment, and prognosis of early versus late recurrence of centrally located hepatocellular carcinoma (CL-HCC) after mesohepatectomy (MH). Three hundred forty eight patients with CL-HCC undergoing MH were included. Data on clinicopathological characteristics, initial surgical details, timing and sites of tumor recurrence, management after recurrence, and long-term outcomes were analyzed. The optimal cutoff value to differentiate early (71 patients, 64.5%) versus late (39, 35.5%) recurrence was defined as 12 months. Patients with early recurrence (ER) had higher alpha fetoprotein (AFP) level (P<.001), more advanced tumor stage (P=.024), and higher incidence of microvascular invasion (MVI, P=.001). Patients with ER had higher incidence of local tumor recurrence (P=.027) and higher average number of recurrent nodules (P=.016) than patients with LR. Patients after ER showed a better overall survival (from date of diagnosis of recurrence) than after late recurrence (LR). Patients with ER had less chances of curative treatment (14.1% vs 41.0%, P=.004) after tumor recurrence than patients with LR. Multivariable analyses revealed that liver cirrhosis (P<.001) and tumor differentiation (P<.001) were associated with an increased likelihood of LR, while multiple tumor number (P=.005), type IV classification (P=.012), and MVI (P<.001) were independent risk factors related to ER. ER and LR after MH for CL-HCC were associated with different risk predictors and prognosis. Data on the timing of recurrence may inform decisions about postoperative adjuvant treatment, as well as help to predict long-term survival for these patients.