Liver resection for recurrent hepatocellular carcinoma to improve survivability: a proposal of indication criteria

Abstract Background Despite curative resection of hepatocellular carcinoma, patients have a high probability of recurrence. We examined indications for liver resection in cases of recurrent hepatocellular carcinoma. Methods Patients undergoing a second liver resection ( n =210) or treatment by transcatheter arterial chemoembolization ( n =184) for recurrent hepatocellular carcinoma of up to 3 lesions were included. We developed a prediction score based on prognostic factors and compared survival according to this prediction score. Results The prediction score was based on 3 independent variables identified by survival analysis in 210 patients undergoing a second liver resection and included age ≥ 75 years, tumor size ≥ 3.0 cm, and multiple tumors. Each patient was assigned a total score. Median overall survival in patients undergoing a second liver resection with scores of 0, 1, and 2/3 were 7.9 years (95% confidence interval, 5.6–NA), 4.5 years (3.8–6.2), and 2.6 years (2.1–5.3), respectively ( P P P = 0.176). Conclusion Liver resection is recommended as first-line therapy for recurrent hepatocellular carcinoma in patients with a score of 0, while those with score 2/3 should be considered candidates for transcatheter arterial chemoembolization.