Risk Factors for Recurrence in Patients with Hepatocellular Carcinoma After Curative Resection or Ablation

Hepatocellular carcinoma (HCC) is the most common liver cancer and has a high incidence in China, largely due to the high prevalence of hepatitis B virus (HBV) infection. HBV‑related HCC often presents with aggressive characteristics but preserved liver function. Resection and ablation are approaches to achieve potentially curative outcomes. However, the recurrence rate is high, with up to 70% within five years. Curative surgery or ablation is used more broadly in China than in Western countries, so identifying patients at high risk of recurrence is essential: risk stratification can inform postoperative management, including surveillance intensity and avoidance of over- or under-treatment. Baseline characteristics provide a simple method of prediction, the impacts of which differ in early and late recurrence. To our knowledge, this is the first narrative review to comprehensively understand the identification, prevalence, and impact of risk factors for both early and late HCC recurrence in Chinese patients following curative‑intent resection or ablation. The review suggests that the most impactful risk factors for early recurrence are aggressive tumor features including tumor size, number and vascular invasion. For late recurrence, key risk factors are patient characteristics such as sex, viral infections and liver cirrhosis. As these risk factors are interrelated, several integrated predictive models like nomograms and artificial intelligence (AI) applications have been proposed, which may enhance risk stratification and inform personalized management strategies. These models should be further validated in large prospective studies to achieve clinical application.