Risk factors for different patterns of recurrence after resection of hepatocellular carcinoma

Long-term survival of patients with hepatocellular carcinoma after hepatectomy is unsatisfactory because of the high recurrence rate.

Among 396 patients who underwent curative resection of hepatocellular carcinoma, there were 228 patients with clinical recurrence: 85 with solitary intrahepatic recurrence (group A), 109 with two or more intrahepatic recurrences (group B), and 34 who had extrahepatic recurrence (group C). The clinical and pathological factors for each group were investigated for association with long-term survival of each group.

The survival rate of group C was significantly lower than that of the other groups. Patients in group C were significantly younger than those in groups A or B, with higher levels of protein induced by absence/antagonism of vitamin K-II, larger tumors, more poorly differentiated tumors, intravascular invasion and a lower incidence of cirrhosis than the other groups. Group A showed a significantly longer period until recurrence and maintained good liver function at recurrence. In group B, the survival rate of Child-Pugh class A patients was significantly higher than that of class B and C patients. Class A patients received significantly more treatments for recurrence than patients in the other classes.

Postoperative adjuvant chemotherapy should be performed as early as possible after hepatectomy if the patient is younger, has a large tumor and/or has a high level of protein induced by absence/antagonism of vitamin K-II. Patients with solitary intrahepatic recurrence and adequate liver function should receive further curative therapy. It is important to maintain the postoperative nutritional status of patients with multiple intrahepatic recurrences in order to allow repeated and aggressive therapy to be performed.