OBJECTIVETo investigate prognostic factors related to early and late intrahepatic recurrences after curative hepatectomy for patients with hepatocellular carcinoma (HCC).

METHODSA retrospective review was conducted on medical records of patients with HCC treated by curative hepatectomy from January 2002 to January 2009. Clinicopathologic data were evaluated for their possible association with postoperative intrahepatic recurrence in univariate and multivariate analysis using Cox proportional hazard model. Recurrence time calculated by Kaplan-Meier method was compared using Log-rank test. Receiver operator characteristic curve (ROC) analysis with calculation of the area under the curve (AUC), sensitivity, and specificity where appropriated and risk stratification were applied to assess predictive ability of prognostic factors.

RESULTSAll 101 patients underwent curative hepatectomy. During follow-up period, 75 patients developed postoperative intrahepatic recurrence, among whom, 63 experienced early recurrence (84.0%) and the remaining had late recurrence (16.0%). The 1-, 2-, 3-and 5-year cumulative recurrent rates were 48.5% (49/101), 62.4% (63/101), 70.3% (71/101) and 74.3% (75/101), respectively. Multivariate analysis identified that tumor residual resectional margin, increased BCLC staging and severity of concomitant liver cirrhosis as independent prognostic factors predicting early recurrence while age ≥ 60 years and presence of tumor capsule predicting late recurrence. Cutoff point values (PI ≥ 2.798) predicted early recurrence with AUC 0.897 (95%CI = 0.829 - 0.965), sensitivity 76.6%and specificity 88.9% calculated from ROC. Median recurrent time of early recurrence and late recurrence reached statistically difference after risk stratification, 20.2 months vs. 4.4 months (χ(2) = 29.198, P = 0.000), 46.6 months vs. 28.6 months (Log-rank test, χ(2) = 8.479, P = 0.004), respectively.

CONCLUSIONSPostoperative recurrence for HCC after curative hepatectomy should be differentiated as early recurrence and late recurrence, since each is associated with different risk factors, indicating possible different mechanism responsible for postoperative recurrence. Risk stratification can be used for prediction of different type of recurrence.