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Cited by 532Hepatocellular Carcinoma Treatment and PrognosisHead and Neck Cancer StudiesHepatitis B Virus Studies

Risk Factors, Patterns, and Outcomes of Late Recurrence After Liver Resection for Hepatocellular Carcinoma: A Multicenter Study From China

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Xu, Xin-Fei, Xing, Hao, Han, Jun, Li, Zhen-Li, Lau, Wan-Yee, Zhou, Ya-Hao, Gu, Wei-Min, Wang, Hong +6 more·2019·JAMA Surgery
DOI 10.1001/jamasurg.2018.4334PMC PMC6439634
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Abstract

Importance: Late recurrence (more than 2 years) after liver resection for hepatocellular carcinoma (HCC) is generally considered as a multicentric tumor or a de novo cancer. Objective: To investigate the risk factors, patterns, and outcomes of late recurrence after curative liver resection for HCC. Design, Setting, and Participants: This study was a multicenter retrospective analysis of patients who underwent curative liver resection for HCC at 6 hospitals in China from January 2001 to December 2015. Among 734 patients who were alive and free of recurrence at 2 years after resection, 303 patients developed late recurrence. Data were analyzed from June 2017 to February 2018. Interventions: Liver resection for HCC. Main Outcomes and Measures: Risk factors of late recurrence as well as patterns, treatments, and long-term outcomes of patients with late recurrence. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors of late recurrence. Results: Of the included 734 patients, 652 (88.8%) were male, and the mean (SD) age was 51.0 (10.3) years. At a median (interquartile range) follow-up of 78.0 (52.8-112.5) months, 303 patients (41.3%) developed late recurrence. Multivariate analysis revealed that male sex, cirrhosis, multiple tumors, satellite nodules, tumor size greater than 5 cm, and macroscopic and microscopic vascular invasion were independent risk factors of late recurrence. Of the 303 patients with late recurrence, 273 (90.1%) had only intrahepatic recurrence, 30 (9.9%) had both intrahepatic and extrahepatic recurrence, and none had only extrahepatic recurrence. Potentially curative treatments were given to 165 of 303 patients (54.5%) with late recurrence, which included reresection, transplant, and local ablation. Multivariate Cox regression analysis showed that regular surveillance for postoperative recurrence (hazard ratio [HR], 0.470; 95% CI, 0.310-0.713; P = .001), cirrhosis (HR, 1.381; 95% CI, 1.049-1.854; P = .02), portal hypertension (HR, 2.424; 95% CI, 1.644-3.574; P < .001), Child-Pugh grade of B or C (HR, 1.376; 95% CI, 1.153-1.674; P < .001), Barcelona Clinic Liver Cancer stage B (HR, 1.304; 95% CI, 1.007-1.708; P = .04) and stage C (HR, 2.037; 95% CI, 1.583-2.842; P < .001), and potentially curative treatment (HR, 0.443; 95% CI, 0.297-0.661; P < .001) were independent predictors of overall survival for patients with late recurrence. Conclusions and Relevance: Late recurrence after HCC resection was associated with sex, cirrhosis, and several aggressive tumor characteristics of the initial HCC. The patterns of late recurrence suggested surveillance for recurrence after 2 years of surgery should be targeted to the liver. Postoperative surveillance improved the chance of potentially curative treatments, with improved survival outcomes in patients with late recurrence.

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  • Late hepatocellular carcinoma recurrence after 12 months probably reflects new primary tumours and is related to the underlying liver disease.

    “By contrast, late HCC recurrence (>12 months) probably reflects new primary tumours (also known as de novo HCCs) and is related to the underlying liver disease.”

    From Adjuvant and neoadjuvant immunotherapies in hepatocellular carcinoma (2024) · cites this paper as [58]

    The Abstract and Discussion associate late recurrence with de novo tumours and underlying hepatitis or cirrhosis. But the paper defines late recurrence as more than 2 years after surgery, not more than 12 months; its findings therefore do not establish the claim for recurrences between 12 and 24 months. Page numbers are not available in the supplied copy. (LLM, conf=0.90)

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Authors
Xu, X.-F., Xing, H., Han, J., Li, Z.-L., Lau, W.-Y., Zhou, Y.-H., Gu, W.-M., Wang, H., Chen, T.-H., Zeng, Y.-Y., Li, C., Wu, M.-C., Shen, F., & Yang, T.
Affiliations
  • Second Military Medical University (CN)
  • Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
  • Chinese University of Hong Kong (HK)
  • Department of Hepatobiliary Surgery, Pu’er People’s Hospital, Yunnan, China
  • Fourth Affiliated Hospital of Harbin Medical University (CN)
  • Department of General Surgery, Liuyang People’s Hospital, Hunan, China
  • Department of General Surgery, Ziyang First People’s Hospital, Sichuan, China
  • Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fujian, China
Corresponding author
  • Shen, Feng
  • Yang, Tian
ORCID
Venue
JAMA Surgery
Publisher
American Medical Association (AMA)
Published
2019-03-01
Volume
154
Issue
3
Pages
209
ISSN
2168-6254 (ISSN-L)
DOI
10.1001/jamasurg.2018.4334
PMC
PMC6439634
OpenAlex
W2900879077
Cited by
532
References
44
Citations by year
2026: 40 · 2025: 89 · 2024: 87 · 2023: 97 · 2022: 86 · 2021: 74 · 2020: 41 · 2019: 17
FWCI
21.62
Type
journal article
Language
en
Open access
Locations
  • JAMA Surgery (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
  • Health Sciences › Medicine › Otorhinolaryngology › Head and Neck Cancer Studies
  • Health Sciences › Medicine › Epidemiology › Hepatitis B Virus Studies
Keywords
hepatocellular carcinoma, late recurrence, hepatectomy, risk factors, liver cirrhosis, satellite nodules, vascular invasion, tumor size, postoperative follow-up, re-resection, liver transplantation, local ablation, extrahepatic recurrence, long-term survival, recurrence patterns, de novo cancer, multicentric tumors, sex differences, extrahepatic metastasis, recurrence-free survival
MeSH terms
China, Female, Carcinoma, Hepatocellular, Humans, Liver Neoplasms, Male, Middle Aged, Neoplasm Recurrence, Local, Retrospective Studies, Risk Factors

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