Predictors of postoperative diffuse intrahepatic recurrence of hepatocellular carcinoma

Diffuse intrahepatic recurrence of hepatocellular carcinoma in the liver remnant carries an extremely poor prognosis compared with other recurrence patterns. We studied the predictors of this type of recurrence.

We determined the risk factors for recurrence and predictors of long-term post-recurrence survival using the Cox's proportional hazard model. We divided 106 patients with recurrent intrahepatic hepatocellular carcinoma into 3 groups based on the number of nodules, and compared clinicopathologic features to determine which risk factors were associated with the diffuse intrahepatic recurrence pattern.

An elevated alpha-fetoprotein concentration, invasive nodular- or massive-type hepatocellular carcinoma, intrahepatic metastasis, the presence of macroscopic ductal invasion, and the lack of a capsule predict diffuse intrahepatic pattern of recurrence. Patients who have three or more of these five factors, are poor candidates for hepatic resection because the likelihood of diffuse intrahepatic recurrence is great, and post-recurrence survival is worse than that with solitary or multiple intrahepatic recurrence.

It is possible to reduce the risks of cancer recurrence at the time of primary resection. It is important to predict the pattern of early diffuse intrahepatic recurrence. In candidates with a poor prognosis, adjuvant therapy or transplantation should be considered.