Utility of Oncological Resectability Criteria in Recurrent Hepatocellular Carcinoma After Hepatectomy.

[INTRODUCTION] Recurrent hepatocellular carcinoma (HCC) after hepatectomy remains a major clinical challenge, necessitating effective prognostic stratification. The oncological resectability criteria recently proposed by the Japan Liver Cancer Association and the Japanese Society of Hepato-Biliary-Pancreatic Surgery have not yet been validated in recurrent settings. This study aimed to evaluate the prognostic utility of these criteria in patients with recurrent HCC after hepatectomy.

[METHODS] This retrospective study included 505 patients with recurrent HCC following initial hepatectomy. Patients were classified into three groups-resectable (R), borderline resectable 1 (BR1), and borderline resectable 2 (BR2)-based on the oncological resectability criteria. Post-recurrence survival was evaluated using the Kaplan-Meier method, and multivariate analysis was performed to identify clinical factors associated with post-recurrence survival.

[RESULTS] Among the 505 patients, 248 patients were classified as R, 80 as BR1, and 177 as BR2. The median post-recurrence survival was 73.4 months for the R group, 33.6 months for the BR1 group, and 12.4 months for the BR2 group (p < 0.001). Multivariate analysis identified BR1/BR2 classification (p < 0.001), modified albumin-bilirubin grade 2b or 3 (p < 0.001), and recurrence within 1 year (p = 0.004) as independent predictors of poor post-recurrence survival.

[CONCLUSIONS] The oncological resectability criteria effectively stratified post-recurrence survival in patients with recurrent HCC. These findings suggest that a multidisciplinary approach may benefit patients with BR1 or BR2 recurrence. Further studies are warranted to explore optimal treatment strategies for recurrent HCC.