Recurrence after surgery for hepatocellular carcinoma: “The seed and the soil” - a multicentre retrospective cohort study

Table 1 Baseline characteristics of patients with hepatocellular carcinoma undergoing primary liver resection

	Baseline characteristics of cohort (n = 235)	Recurrence, n = 94 (40)	No recurrence, n = 141 (60)
Patient factors
Recurrence by aetiology
HCV	71 (30)	36 (51)	35 (49)
HBV	94 (40)	33 (35)	61 (65)
MASLD/alcohol	70 (30)	25 (36)	45 (34)
Age, years [median (q1-q3)]	64 (57-70)	64 (56-71)	65 (57-70)
Male sex	183 (78)	74 (40)	109 (60)
Diabetes (T2DM)	79 (34)	28 (35)	51 (65)
Liver factors
Cirrhosis
No	92 (39)	35 (38)	57 (62)
Yes	143 (61)	59 (41)	84 (59)
Child Pugh
No cirrhosis	92 (39)	35 (38)	57 (62)
A5	112 (48)	43 (38)	69 (62)
≥ A6	31 (13)	16 (52)	15 (48)
MELD 3.0 score
No cirrhosis	92 (39)	35 (38)	57 (62)
6	27 (11)	6 (22)	21 (78)
7	35 (15)	17 (49)	18 (51)
8	31 (13)	13 (42)	18 (58)
≥ 9	50 (21)	23 (46)	27 (54)
ALBI grade
1	157 (67)	61 (39)	96 (61)
≥ 2	78 (33)	33 (42)	45 (58)
Platelet count
≤ 150	62 (26)	23 (37)	39 (63)
> 150	173 (74)	71 (41)	102 (59)
Tumour factors
AFP (ng/mL)
< 400	188 (80)	75 (40)	113 (60)
≥ 400	22 (9)	9 (41)	13 (59)
Unknown AFP at diagnosis	25 (11)	10 (40)	15 (60)
BCLC
0	42 (18)	14 (33)	28 (67)
A	159 (68)	66 (42)	93 (58)
B	20 (8)	9 (45)	11 (55)
C	14 (6)	5 (36)	9 (64)
UCSF criteria
In	195 (83)	78 (40)	117 (60)
Out	40 (17)	16 (40)	24 (60)
Number of nodules
1	192 (82)	80 (42)	112 (58)
2	29 (12)	9 (31)	20 (69)
≥ 3	14 (6)	5 (36)	9 (64)
Size of largest nodule/s
< 3 cm	100 (43)	36 (36)	64 (64)
3-4.9 cm	68 (29)	27 (40)	41 (60)
5-10 cm	50 (22)	26 (52)	24 (48)
> 10 cm	17 (7)	5 (29)	12 (71)
Presence of macroscopic vascular invasion (or tumour rupture/bleed)
Yes	14 (6)	5 (36)	9 (74)
No	221 (94)	89 (40)	132 (60)

Clinical, liver disease-related, and tumour-related characteristics of the study cohort stratified by recurrence status. Values are presented as n (%) or median (interquartile range). We performed univariate (unadjusted) analysis and identified factors associated with hepatocellular carcinoma recurrence including age, the presence of cirrhosis, Child-Pugh score, model for end-stage liver disease 3.0 score, albumin-bilirubin grade grade, aetiology, and University of California San Francisco criteria, Barcelona Clinic Liver Cancer staging system (BCLC) stage, nodule size and macrovascular invasion (Table 2). Multivariate analysis found the albumin-bilirubin score, if ≥ 2; adjusted hazard ratio (aHR): 2.24 (1.43-3.52) P < 0.001, the presence of cirrhosis; aHR: 2.21 (1.42-3.43) P < 0.001 and those with Barcelona Clinic Liver Cancer stage B/C; aHR: 2.51 (1.41-4.47) P = 0.002 as independent predictors of recurrence. AFP: Alpha-fetoprotein; ALBI: Albumin-bilirubin grade; BCLC: Barcelona Clinic Liver Cancer; HBV: Hepatitis B virus; HCV: Hepatitis C virus; MASLD: Metabolic dysfunction-associated steatotic liver disease; MELD: Model for end-stage liver disease; T2DM: Type 2 diabetes mellitus; UCSF: University of California San Francisco criteria.