Multimodal treatment modalities are associated with improved long-term outcome in patients with recurrent hepatocellular carcinoma

Abstract

Background: Tumor recurrence after liver-resection remains a major problem in hepatocellular carcinoma (HCC). We evaluated prognostic markers for HCC tumor recurrence (TR) and overall survival (OS) in patients who underwent liver-resection in curative intent. Furthermore, we examined the effect of multimodal treatment on OS in a subgroup of patients with HCC-recurrence. Methods: Between 2009-2015 96 patients underwent surgical resection for HCC at our institution. Median follow-up was 50 month. In cases of TR, patients underwent repeated liver-resection, liver transplantation, local-ablative procedures or palliative treatments. The associations of recurrence-free-survival (RFS) and OS with clinicopathological characteristics were assessed using univariate survival analyses. Results: Median OS was 31 months and median RFS was 30 months. Macrovascular invasion (p=0.001), Milan-criteria (p=0.013), number of nodules (p<0.001) and largest tumor diameter (p=0.023) were associated with RFS. In patients with TR (54%), we did not observe an association with OS (p=0.488). Nevertheless, patients with HCC-recurrence who underwent repeat-surgical or interventional treatment showed significant improved OS compared to patients treated with palliative treatment alone (OS: 32m vs. 13m; p<0.001). Conclusion: Tumor recurrence alone is not associated with poor oncological outcome and repeat liver resections and local-ablative procedures are crucial to improve OS in HCC. Large prospective trials are needed to validate our findings.