Patterns and outcomes of early and late recurrence after hepatectomy for hepatocellular carcinoma with microvascular invasion: a multicenter study in China

Xiu-Ping Zhang ¹, Tian-Chen Zhang ^1,2, Fei-Fan Wu ¹

¹Faculty of Hepato-Biliary-Pancreatic Surgery, the First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Chinese PLA Medical School, Beijing, China.
²The First School of Clinical Medicine, First Affiliated Hospital of Lanzhou University, Lanzhou, China.
³Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Navy Military Medical University, Shanghai, China.
⁴Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
⁵Department of Hepatobiliary and Pancreatic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
⁶Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
⁷Department of Hepatic Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, China.
⁸Faculty of Hepato-Pancreato-Biliary Surgery, The Sixth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China.
⁹Department of Hepatobiliary Pancreatic Surgery, The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
¹⁰Department of General Surgery, Shandong University Qilu Hospital, Jinan, China.
¹¹Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, China.
¹²Department of General Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
¹³General Surgery Clinical Medicine Center, Gansu Provincial Hospital, Lanzhou, China.
¹⁴Department of Hepatobiliary Surgery, General Hospital of Northern Theater Command, Shenyang, China.
¹⁵Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
¹⁶Department of General Surgery, General Hospital of Central Theater Command, Wuhan, China.
¹⁷Department of General Surgery, The Third Clinical College of Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China.
¹⁸Department of Hepatobiliary Surgery, The Second Hospital Affiliated to NanChang University, Nanchang, China.
¹⁹Department of Hepatobiliary Pancreatic Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou, China.
²⁰Department of General Surgery, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
²¹Department of General Surgery, The 940Th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China.
²²Department of Hepatobiliary Surgery, The Fifth People's Hospital of Datong, Datong, China.
²³Department of Hepatobiliary Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.
²⁴Department of Hepatobiliary Surgery, Xing'an League People's Hospital, Hinggan, China.
²⁵Department of Hepatobiliary Surgery, Linyi People's Hospital, Linyi, China.
²⁶Department of Hepatobiliary Surgery, Chifeng Municipal Hospital, Chifeng, China.
²⁷Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Navy Military Medical University, Shanghai, China. chengshuqun@aliyun.com.
²⁸Faculty of Hepato-Biliary-Pancreatic Surgery, the First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Chinese PLA Medical School, Beijing, China. hmg301@126.com.
²⁹Faculty of Hepato-Biliary-Pancreatic Surgery, the First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Chinese PLA Medical School, Beijing, China. liurong301@126.com.
³⁰The First School of Clinical Medicine, First Affiliated Hospital of Lanzhou University, Lanzhou, China. liurong301@126.com.

⁰Faculty of Hepato-Biliary-Pancreatic Surgery, the First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Chinese PLA Medical School, Beijing, China.

Hepatology International +

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March 10, 2025

View abstract on PubMed

Summary

Hepatocellular carcinoma (HCC) with microvascular invasion (MVI) often recurs early after surgery, leading to poorer survival. Regular postoperative surveillance improves outcomes for these patients.

Area Of Science

Hepatobiliary surgery
Surgical oncology
Gastroenterology

Background

Limited data exists on long-term outcomes and surveillance for hepatocellular carcinoma (HCC) with microvascular invasion (MVI) post-hepatectomy recurrence.
Understanding early (ER) versus late recurrence (LR) patterns and prognosis is crucial for patient management.

Purpose Of The Study

To investigate the patterns and prognosis of early and late recurrence (ER and LR) after hepatectomy in patients with HCC and MVI.
To compare overall survival (OS) and post-recurrence survival (PRS) between ER and LR groups.

Main Methods

A retrospective analysis of 2828 patients with HCC and MVI who underwent hepatectomy across 26 centers in China (2009-2020).
Comparison of OS and PRS using Kaplan-Meier method and log-rank test.
Analysis of recurrence patterns (intra-hepatic vs. extra-hepatic) and impact of surveillance regularity.

Main Results

1200 patients experienced ER and 607 experienced LR. Intra-hepatic recurrence was most common.
Median OS was significantly shorter for ER (20.2 months) and LR (52.6 months) compared to non-recurrence (58.9 months).
ER patients had worse PRS (14.3 months) than LR patients (18.9 months). Regular surveillance improved OS and PRS.

Conclusions

Patients with HCC and MVI are prone to ER within one year, associated with a worse prognosis than LR.
Intra-hepatic recurrence is the predominant pattern for both ER and LR.
Postoperative surveillance is associated with improved survival outcomes in recurrent HCC patients.

Keywords:

Early recurrence HCC Hepatectomy MVI Overall survival Post-recurrence survival Recurrence patterns Recurrence site Surgical outcomes Surveillance