Pathologic treatment effect and first recurrence behavior after curative liver surgery for HCC.

Abstract

e16287 Background: Locoregional therapy (LRT) is frequently used before curative-intent liver resection or transplantation for hepatocellular carcinoma (HCC), yet it remains uncertain whether the degree of pathologic treatment effect provides independent prognostic information beyond tumor burden and biology. Methods: In a cohort undergoing curative-intent liver surgery (N = 284), we evaluated whether pathologic treatment effect (categorized as none/partial/complete) predicted (1) time to first recurrence (Cox proportional hazards), (2) early recurrence (≤24 months; multivariable logistic regression), and (3) extrahepatic involvement at first relapse among patients with recurrence (logistic regression; n = 80). Models adjusted for age, MELD, log10(AFP+1), tumor diameter, multifocality, and microvascular invasion, with surgery type (transplant vs resection) included as a key clinical covariate. Results: Pathologic treatment effect was not independently associated with time to recurrence or early recurrence (all p > 0.34). Larger tumor diameter and multifocality were consistently associated with higher recurrence risk, while transplantation (vs resection) was associated with lower recurrence risk and lower odds of early recurrence. Among patients who recurred (n = 80), transplantation was associated with increased odds of extrahepatic involvement at first relapse (OR 7.84, p = 0.020). Conclusions: Pathologic treatment effect did not improve prediction of post-operative recurrence outcomes beyond established tumor and treatment factors. Recurrence risk was primarily driven by tumor burden (diameter, multifocality) and surgery type. Among patients who recur, transplant recipients demonstrated higher odds of extrahepatic involvement at first relapse, supporting focused relapse-phenotype surveillance strategies in this subgroup. Key adjusted associations (multivariable models). Variable Time to First Recurrence HR (95% CI), p Early Recurrence ≤24 Months OR (95% CI), p Extrahepatic Involvement at First Relapse OR (95% CI), p* Partial vs none 0.77 (0.44–1.33), 0.341 1.08 (0.39–3.03), 0.880 1.57 (0.24–10.16), 0.634 Complete vs none 1.02 (0.69–1.51), 0.928 1.34 (0.68–2.63), 0.399 2.42 (0.83–7.04), 0.106 Transplant vs resection 0.43 (0.28–0.68), <0.001 0.15 (0.06–0.40), <0.001 7.84 (1.39–44.17), 0.020 Tumor diameter (per cm) 1.08 (1.02–1.14), 0.008 1.12 (1.02–1.22), 0.014 1.04 (0.91–1.18), 0.577 Multifocality (multiple tumors) 1.58 (1.06–2.37), 0.025 2.06 (1.04–4.10), 0.039 0.70 (0.23–2.10), 0.524