Prognosis of repeat hepatectomy for liver transplantable hepatocellular carcinoma recurrence after hepatectomy: A Retrospective Cohort Study with the Hiroshima Surgical Study Group of Clinical Oncology (HiSCO)

Abstract

Abstract Background Factors affecting the prognosis of repeat hepatectomy for transplantable hepatocellular carcinoma recurrence after hepatectomy remains unclear. We aimed to clarify the prognostic factors for transplantable and non-transplantable hepatocellular carcinoma recurrence after hepatectomy.Methods We included 486 repeat hepatectomies out of 2,244 for hepatocellular carcinoma performed between 2006 and 2017 using the Hiroshima Study Group for Clinical Oncology and Surgery database. Prognostic factors were analyzed in patients who underwent a repeat hepatectomy for hepatocellular carcinoma recurrence after hepatectomy, dividing them into transplantable (defined as age < 70 years at the time of recurrence and recurrent tumor morphology that meets Japanese criteria) and non-transplantable group were analyzed.Results The 5-year overall survival rate after repeat hepatectomy was 63.2%, while the 5-year recurrence-free survival rate was 23.7%. In the transplantable recurrence group, mALBI grade 2b, AFP > 100ng/ml, DCP > 100mAU/ml, max tumor size > 20mm, and multiple tumors were independent prognostic risk factors for overall survival. Patients with two or more risk factors had a significantly lower survival rate, only 40.4% at five years compared to those with one or fewer risk factors (86.3% at five years). In the non-transplantable recurrence group, early recurrence (< 365 days), mALBI grade 2b, and DCP > 100mAU/ml were independent prognostic factors of overall survival.Conclusions We identified the risk factors involved in post-hepatectomy survival for patients with transplantable recurrence after hepatectomy. The results are a potential indicator of whether salvage liver transplantation should be considered during repeat hepatectomy.