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Background <p>The factors associated with extrahepatic recurrence (EHR) after curative resection for hepatocellular carcinoma (HCC) have rarely been investigated. This study examined the pre- and postoperative predictors of EHR after curative resection in HCC patients over a ten-year follow-up period.</p> Methods <p>A retrospective review was conducted on treatment-naïve HCC patients who underwent curative resection between 2004 and 2019 at four tertiary hospitals in South Korea. The cohort of 1,069 patients was divided into a derivation cohort (<i>n</i> = 683) and a validation cohort (<i>n</i> = 386) based on participating institutions.</p> Results <p>In the derivation cohort, the mean age was 59.8 years, and 85.7% were male. The majority of patients (98.7%) had compensated liver cirrhosis, and chronic hepatitis B was the prevalent etiology (72.9%). EHR developed in 107 patients (15.7%) and was associated with younger age, advanced tumor stages, and histological features including larger tumor size, a higher number of tumors, the presence of microvascular invasion, serosal nvasion, intrahepatic metastasis, and necrosis. According to multivariable Cox regression analyses, younger age, a higher modified Union for International Cancer Control (UICC) stage, exceeding the Milan criteria, and an albumin–bilirubin (ALBI) grade ≥ 2 were independently significant preoperative factors associated with EHR. Similarly, age, tumor number, the presence of microvascular invasion, necrosis, exceeding the Milan criteria, and an ALBI grade ≥ 2 were independently significant postoperative factors. Kaplan–Meier plots clearly differentiated EHR-free survival among the risk groups stratified by our EHR-preop and EHR-postop models. The EHR-preop and EHR-postop models, developed in the derivation cohort, were applied to the validation cohort and showed clear separation among risk groups.</p> Conclusion <p>Our study developed and validated predictive models (EHR-preop and EHR-postop) to identify the risk of EHR after curative HCC resection. The models could potentially enhance clinical decision-making by identifying patients at elevated EHR risk thus advancing personalized HCC care.</p> Graphical Abstract <p></p>

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Pre- and postoperative predictors of extrahepatic recurrence after curative resection for hepatocellular carcinoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月23日

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  • Chang Hun Lee,
  • Yun Chae Lee,
  • Seung Young Seo,
  • Ga Ram You,
  • Hoon Gil Jo,
  • Sung Bum Cho,
  • Eun Young Cho,
  • In Hee Kim,
  • Sung Kyu Choi,
  • Jae Hyun Yoon

摘要

Background

The factors associated with extrahepatic recurrence (EHR) after curative resection for hepatocellular carcinoma (HCC) have rarely been investigated. This study examined the pre- and postoperative predictors of EHR after curative resection in HCC patients over a ten-year follow-up period.

Methods

A retrospective review was conducted on treatment-naïve HCC patients who underwent curative resection between 2004 and 2019 at four tertiary hospitals in South Korea. The cohort of 1,069 patients was divided into a derivation cohort (n = 683) and a validation cohort (n = 386) based on participating institutions.

Results

In the derivation cohort, the mean age was 59.8 years, and 85.7% were male. The majority of patients (98.7%) had compensated liver cirrhosis, and chronic hepatitis B was the prevalent etiology (72.9%). EHR developed in 107 patients (15.7%) and was associated with younger age, advanced tumor stages, and histological features including larger tumor size, a higher number of tumors, the presence of microvascular invasion, serosal nvasion, intrahepatic metastasis, and necrosis. According to multivariable Cox regression analyses, younger age, a higher modified Union for International Cancer Control (UICC) stage, exceeding the Milan criteria, and an albumin–bilirubin (ALBI) grade ≥ 2 were independently significant preoperative factors associated with EHR. Similarly, age, tumor number, the presence of microvascular invasion, necrosis, exceeding the Milan criteria, and an ALBI grade ≥ 2 were independently significant postoperative factors. Kaplan–Meier plots clearly differentiated EHR-free survival among the risk groups stratified by our EHR-preop and EHR-postop models. The EHR-preop and EHR-postop models, developed in the derivation cohort, were applied to the validation cohort and showed clear separation among risk groups.

Conclusion

Our study developed and validated predictive models (EHR-preop and EHR-postop) to identify the risk of EHR after curative HCC resection. The models could potentially enhance clinical decision-making by identifying patients at elevated EHR risk thus advancing personalized HCC care.

Graphical Abstract