Long-term outcomes following aggressive management of recurrent hepatocellular carcinoma after upfront liver resection.

Background: Long-term outcomes of patients who experience recurrence after liver resection (LR) of hepatocellular carcinoma (HCC) are uncertain.

Methods: The characteristics of 58 patients were obtained from a retrospective database at two time points: primary resection and recurrence. Patterns of recurrence, treatment strategies, and long-term survival rates were analyzed.

Results: The recurrence was inside the Milan criteria (Milan+) in 19 patients (32.7 %), 11 of whom were already eligible for a liver transplant (LT) at the time of primary liver resection (LR). Treatment of the recurrence included the following procedures: salvage LT (n = 6; 10.3 %), repeat LR (n = 7; 12.1 %), percutaneous radiofrequency ablation (RFA) and/or transarterial chemoembolization (TACE) (n = 24; 41.3 %), systemic chemotherapy (n = 15; 25.8 %), and best supportive care (n = 12; 20.7 %). With a mean follow-up of 26.9 ± 27.9 months, the overall 1-, 3-, and 5-year survival rates of the 58 patients with HCC recurrence after primary LR were 57.3, 42.5, and 35.3 %, respectively. In the multivariate analysis the presence of esophageal varices (p = 0.001), an AFP level >200 μg/L (p = 0.03) and a Milan- recurrence pattern (p = 0.05) were independent predictors of decreased survival. The overall 5-year survival of patients who experienced Milan+ recurrence was comparable to that of Milan+ patients who underwent primary LR (62.5 % vs. 66.3 %, p = 0.48).

Conclusions: Aggressive management of recurrent HCC after upfront LR improves patient survival. The pattern of recurrence is an independent predictor of survival which can be used as a selection criterion for salvage LT.