Gastrointestinal Cancer

Background and Aim: Primary liver cancer is the third leading cause of cancer-related death worldwide, with hepatocellular carcinoma (HCC) accounting for 80% of primary liver cancers.Liver resection is a curative treatment for early HCC (more than 2cm or when inaccessible to locoregional ablation), however there is a paucity of literature on predicting the likelihood of HCC recurrence following resection.We evaluated factors related to recurrence following primary HCC resection with curative intent.Methods: We retrospectively reviewed the electronic medical records of patients with HCC who underwent primary resection at three tertiary referral hospitals in Australia between January 2008 and May 2022.Baseline and follow-up characteristics, including liver disease, patient, and tumour characteristics were collected.The incidence rate of HCC recurrence following curative resection, and the factors associated with recurrence risk was evaluated.Results: A total of 242 patients underwent surgical resection with a median follow up of 36.6 months (IQR: 13.8-60.5).The overall survival rate at 3 years was 54%, with total disease-free survival at 3 years 29%.Underlying HCC aetiology was hepatitis C virus (HCV) in 73 (30%), hepatitis B virus (HBV) in 98 (41%) and non-viral in 71 (29%).Clear histological margins and complete post-operative radiological response was achieved in 190 (79%) patients with 1 (0.4%) 90-day mortality.Recurrence occurred in 94 (39%) with median time to recurrence of 18.8 months (IQR: 8.6-35]).The incidence rate of recurrence was 10.5 per 100 person-years (95% CI: 8.6 -12.9).Multivariate Cox regression analysis identified an increased risk of HCC recurrence was independently associated with: MELD score > 7 (aHR: 2.36; 95% CI: 1.20-4.63;p = 0.012), Alpha-fetoprotein (AFP) > 400 (aHR: 4.76; 95% CI: 2.07-10.91;p < 0.001), albumin-bilirubin (ALBI) grade > 2 (aHR: 1.71; 95% CI: 1.00-2.90;p = 0.049) and if tumour was outside UCSF criteria (aHR: 2.09; 95% CI: 1.08-4.04;p = 0.029).HCC aetiology was not associated with recurrence risk.Conclusion: HCC recurrence in those having liver resection is more likely in those with worse liver function and those with tumours outside the UCSF criteria.Enhanced post-surgical interval surveillance could be considered for patients with this risk profile.