Management of intrahepatic recurrence after resection for hepatocellular carcinoma exceeding the barcelona clinic liver cancer criteria

BACKGROUND: Although patients with Barcelona clinic liver cancer stage B or C hepatocellular carcinoma derive survival benefit from hepatectomy, prognostic factors and management after curative resection are unclear. This study aims to evaluate predictive factors, therapy and prognosis of intra-hepatic recurrences after curative resection of Barcelona clinic liver cancer stage B or C hepatocellular carcinoma. METHODS: We retrospectively analyzed 397 patients with Barcelona clinic liver cancer stage B or C hepatocellular carcinoma who underwent curative resections from January 1989 to October 2011. Intra-hepatic recurrences were classified into early (<2 year) and late (≥2 year) recurrences. RESULTS: Overall survival rates in our cohort were 1-year: 81.4%; 3-year: 48.5%; and 5-year: 28.2%. Early and late intra-hepatic recurrences developed in 104 patients and 73 patients, respectively. In univariate analysis, overall survival for the non-recurrence group was significantly better than for the recurrence group (P<0.001), and overall survival for the late recurrence group was significantly better than for the early recurrence group (P<0.001). In multivariate analysis, total tumor size, tumor number and vascular invasion were significant risk factors for tumor recurrence (P<0.001). The overall survival of patients with late recurrence who received curative treatment was comparable to those who never had tumor recurrences (P=0.140). CONCLUSION: Time to recurrence and feasibility of curative treatment are the best determinants for prognosis in Barcelona clinic liver cancer stage B or C hepatocellular carcinoma. Curative treatments may prolong overall survival of patients with late recurrences, but should be avoided for those with early recurrences.