Survival according to recurrence patterns after resection for transplantable hepatocellular carcinoma in HBV endemic area: Appraisal of liver transplantation strategy

Chung Gyo Seo, Sun Young Yim, Soon Ho Um, Yoo Ra Lee, Yoo Jin Lee, Tae Hyung Kim, Hyun Gil Goh, Young Sun Lee, Sang Jun Suh, Na Yeon Han, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Hyung Joon Yim, Ji Hoon Kim, Dong Sik Kim, Yoon Tae Jeen, Hoon Jai Chun, Hong Sik LeeChang Duck Kim

Research output: Contribution to journalArticle


Background and aims: Since there is a shortage of liver donors, we investigated recurrence patterns and outcomes after liver resection (LR) to determine the feasibility of salvage liver transplantation (SLT). Methods: We analyzed 468 patients with hepatocellular carcinoma (HCC) within the Milan criteria (MC) who were mainly associated with Hepatitis B virus infection (76.3%) and had undergone curative LR as an initial treatment. Results: The overall survival (OS) rates were 86.6% and 67.4% at 5 and 10 years after LR, respectively. During a median follow-up of 59 months, 211 patients experienced recurrences including 175 (37.4%) within MC and 36 (7.7%) beyond MC. Survival was lowest in patients with beyond MC-recurrence followed by within MC- and no-recurrence groups (26.5%, 86.6%, and 94.7% at 5 years, respectively, P < 0.001). Independent pathologic predictors of recurrence beyond MC were the presence of satellite nodules, microvascular invasion, and unfavorable gross findings (multinodular confluent and infiltrative) (all, P < 0.05). Patients with all three risk factors experienced recurrence with the highest cumulative incidence of mortality. Among 173 patients with recurrence within MC, the cumulative incidence of HCC progression beyond MC despite resection and locoregional treatment (LRT) was 29% and 60% at 5 and 10 years after recurrence, respectively, and their 10-year OS rate was 25.8%. Conclusion: Curative LR achieved a 5-year survival of > 85% in patients with transplantable HCC, but early SLT after recurrence within MC is advocated because of poor survival and high risk of progression thereafter. Further, prophylactic LT could be considered for those with high risk of recurrence.

Original languageEnglish
JournalClinics and Research in Hepatology and Gastroenterology
Publication statusAccepted/In press - 2019 Jan 1



  • Hepatocellular carcinoma
  • Liver resection
  • Milan criteria
  • Recurrence
  • Risk factor
  • Salvage liver transplantation

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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