Substantial risk of recurrence even after 5 recurrence-free years in early-stage hepatocellular carcinoma patients

Clin Mol Hepatol. 2020 Oct;26(4):516-528. doi: 10.3350/cmh.2020.0016. Epub 2020 Sep 11.


Background/aims: Although hepatocellular carcinoma (HCC) is notorious for its high recurrence rate, some patients do not experience recurrence for more than 5 years after resection or radiofrequency ablation for early-stage HCC. For those with five recurrence-free period, the risk of HCC recurrence within the next 5 years remains unknown.

Methods: A total of 1,451 consecutive patients (median, 55 years old; males, 79.0%; hepatitis B virus-related, 79.3%) with good liver function (Child-Pugh class A) diagnosed with early-stage HCC by Barcelona Clinic Liver Cancer Staging and received radiofrequency ablation or resection as an initial treatment between 2005 and 2010 were analyzed.

Results: During a median follow-up period of 8.1 years, 961 patients (66.2%) experienced HCC recurrence. The cumulative recurrence rates increased to 39.7%, 60.3%, and 71.0% at 2, 5, and 10 years, respectively, and did not reach a plateau. Five years after HCC diagnosis, 487 patients were alive without experiencing a recurrence. Among them, during a median of 3.9 additional years of follow-up (range, 0.1-9.0 years), 127 patients (26.1%) experienced recurrence. The next 5-year cumulative recurrence rate (5-10 years from initial diagnosis) was 27.0%. Male sex, higher fibrosis-4 scores, and alpha-fetoprotein levels at 5 years were associated with later HCC recurrence among patients who did not experience recurrence for more than 5 years.

Conclusion: The HCC recurrence rate following 5 recurrence-free years after HCC treatment was high, indicating that HCC patients warrant continued HCC surveillance, even after 5 recurrence-free years.

Keywords: Carcinoma, Hepatocellular; Long-term; Recurrence; Treatment.

MeSH terms

  • Carcinoma, Hepatocellular / pathology*
  • Catheter Ablation*
  • Child, Preschool
  • End Stage Liver Disease*
  • Humans
  • Liver Neoplasms* / pathology
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Treatment Outcome