Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma

Prognostic factors for hepatocellular carcinoma recurrence

“…Recurrent tumors could originate from either intra-hepatic metastasis from the primary tumor or multi-centric occurrence arising from persistent fibrosis and hepatitis-related carcinogenicity in the remnant liver. As a result of clinical and molecular studies conducted in the late nineties and early 2000s, HCC recurrence after hepatic resection is currently divided into early recurrence (within 1 or 2 years after surgery) and late recurrence (greater than these temporal end-points) [46][47][48] . Early recurrences are considered to result from intra-hepatic metastasis of the primary HCC, and are mainly affected by adverse tumor features whereas late recurrences should be considered as de novo HCCs and are mainly affected by the underlying liver status [46][47][48] .…”

“…As a result of clinical and molecular studies conducted in the late nineties and early 2000s, HCC recurrence after hepatic resection is currently divided into early recurrence (within 1 or 2 years after surgery) and late recurrence (greater than these temporal end-points) [46][47][48] . Early recurrences are considered to result from intra-hepatic metastasis of the primary HCC, and are mainly affected by adverse tumor features whereas late recurrences should be considered as de novo HCCs and are mainly affected by the underlying liver status [46][47][48] . Among the various tumor factors involved in determining the prognosis after resection for HCC, tumor size, multifocal disease, and the presence of vascular invasion or of poor histological differentiation, have been reported to be able to predict early recurrence [49][50][51][52][53][54][55][56] .…”

“…Among the various tumor factors involved in determining the prognosis after resection for HCC, tumor size, multifocal disease, and the presence of vascular invasion or of poor histological differentiation, have been reported to be able to predict early recurrence [49][50][51][52][53][54][55][56] . The presence of cirrhosis represents a risk factor for de novo HCC when compared to patients having chronic hepatitis without cirrhosis and, among cirrhotic patients, it has been reported that some cirrhotic characteristics, such as previous surgery either alone or together with increased aspartate aminotransferase (AST) levels and Ishak activity can determine a high-risk profile for the development of late recurrence [46] .…”

“…Micro-vascular invasion is usually defined as the presence of tumor emboli within the central hepatic vein, the portal vein, or the large capsular vessels [46] . The presence of MVI is related to a hazard ratio of 1.8 and a 1.4-fold decrease of time-to-recurrence [53] ; however, great heterogeneity can be found in the literature, mainly as a consequence of inter/intra-observer variability in reporting the grading of micro-vascular invasion [57] .…”

Clonality Analysis for Multicentric Origin and Intrahepatic Metastasis in Recurrent and Primary Hepatocellular Carcinoma

“…HCC with IM recurs earlier and has a poorer prognosis than that with MO. [8][9][10][11] Aggressive therapy may not be warranted in cases with IM, but in cases with MO, intervention should be taken within the limits of liver functional reserve. 12 Most of these reports refer to HCC related to HCV; however, the incidence and clinicopathologic features of HCC associated with HBV remain unclear.…”