Survival impact and recurrence prediction using oncologic resectability classification in hepatocellular carcinoma following hepatic resection: a Japanese multi-center study.

Background: The oncological criteria of resectability for HCC were reported by the Japanese Expert Consensus 2023. The relationship between classification at recurrence and prognosis is unclear in cases with surgical resection in the initial treatment. Factors that predict recurrence patterns are also unknown.

Methods: Data were analyzed retrospectively from 937 patients who underwent hepatic resection for primary HCC at 10 facilities. Kaplan-Meier analyses of overall survival (OS) and recurrence-free survival (RFS) after hepatic resection defined according to resectability classification, resectable (R), borderline resectable (BR) 1, and BR2, were performed. In patients who underwent curative resection for R-HCC, we examined the classification and prognosis at the time of recurrence, as well as the factors associated with BR1 or BR2 recurrence.

Results: RFS and OS rates were significantly better in the R group than in the BR1 and BR2 groups (P < 0.01). Prognosis was worse in patients whose initial HCC was resected with R and whose recurrence was BR1 or BR2 (P < 0.01). Male sex, α-fetoprotein > 12 ng/dL, Des-γ-carboxy prothrombin > 150 mAU/mL, tumor size > 5 cm, poor differentiation, and microscopic vascular invasion were predictors of BR1 or BR2 recurrence within 2 years after curative resection for R-HCC. We developed a scoring system based on these six factors, which stratified not only prognosis but also recurrence pattern.

Conclusions: Our results extend this framework by demonstrating the prognostic significance at the time of recurrence and provide factors to predict high-risk recurrence.