Background and Aims: Hepatocellular carcinoma (HCC) recurrence is common in patients treated with liver resection (LR). In this study, we aimed to evaluate the incidence and preoperative predictors of non-transplantable recurrence in patients with single HCC <= 5 cm treated with frontline LR.Methods: From the Italian Liver Cancer (ITA. LI.CA) database, 512 patients receiving frontline LR for single HCC <= 5 cm were retrieved. Incidence and predictors of recurrence beyond Milan criteria (MC) and up-to- seven criteria were compared between patients with HCC <4 and >= 4 cm.Results: During a median follow-up of 4.2 years, the overall recurrence rate was 55.9%. In the >= 4 cm group, a significantly higher proportion of patients recurred beyond MC at first recurrence (28.9% vs. 14.1%; p < 0.001) and overall (44.4% vs. 25.2%; p < 0.001). Similar results were found considering recurrence beyond up-to-seven criteria. Compared to those with larger tumours, patients with HCC <4 cm had a longer recurrence-free survival and overall survival. HCC size >= 4 cm and high alpha-fetoprotein (AFP) level at the time of LR were independent predictors of recurrence beyond MC (and up-to-seven criteria). In the subgroup of patients with available histologic information (n = 354), microvascular invasion and microsatellite lesions were identified as additional independent risk factors for non-transplantable recurrence.Conclusions: Despite the high recurrence rate, LR for single HCC <= 5 cm offers excellent long-term survival. Non-transplantable recurrence is predicted by HCC size and AFP levels, among pre- operatively available variables. High-risk patients could be considered for frontline LT or listed for transplantation even before recurrence.
Predictors of non-transplantable recurrence in hepatocellular carcinoma patients treated with frontline liver resection / Pelizzaro, Filippo; Trevisani, Franco; Simeon, Vittorio; Vitale, Alessandro; Cillo, Umberto; Piscaglia, Fabio; Missale, Gabriele; Sangiovanni, Angelo; Foschi, Francesco G; Cabibbo, Giuseppe; Caturelli, Eugenio; Di Marco, Maria; Azzaroli, Francesco; Brunetto, Maurizia R; Raimondo, Giovanni; Vidili, Gianpaolo; Guarino, Maria; Gasbarrini, Antonio; Campani, Claudia; Svegliati-Baroni, Gianluca; Giannini, Edoardo G; Mega, Andrea; Masotto, Alberto; Rapaccini, Gian Ludovico; Magalotti, Donatella; Sacco, Rodolfo; Nardone, Gerardo; Farinati, Fabio. - In: LIVER INTERNATIONAL. - ISSN 1478-3231. - (2023). [10.1111/liv.15719]