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

Table 2 Factors associated with hepatocellular carcinoma recurrence following primary liver resection, Cox proportional hazard model assessing hepatocellular carcinoma recurrence following primary liver resection (n = 235)

		Unadjusted model		Adjusted model 1		Adjusted model 2		Adjusted model 3		Adjusted model 4
Characteristics	Rate of recurrence (95%CI), per 100 person-years	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
Patient factors
Age, year	N/A	1.02 (1.01-1.04)	0.019	1.03 (1.00-1.05)	0.019	1.02 (1.00-1.05)	0.043	1.02 (1.00-1.04)	0.108	1.03 (1.01-1.05)	0.017
Sex
Male	10.5 (8.4-13.2)	1.00
Female	11.3 (7.3-17.6)	1.14 (0.70-1.88)	0.598
Diabetes (T2DM)
Nil diabetes	10.8 (8.5-13.8)	1.00
T2DM	10.3 (7.1-15.0)	1.09 (0.70-1.71)	0.704
Liver factors
Cirrhosis
No	7.8 (5.6-10.9)	1.00								1.00
Yes	13.5 (10.5-17.3)	2.21 (1.42-3.43)	< 0.001							2.03 (1.27-3.25)	0.003
Child Pugh
No cirrhosis	8.0 (5.8-11.2)	1.00		1.00
A5	11.8 (8.8-15.9)	1.87 (1.17-2.97)	0.008	1.73 (1.06-2.83)	0.029
> A6	19.7 (12.1-32.2)	3.24 (1.76-5.98)	< 0.001	2.85 (1.50-5.42)	0.001
MELD 3.0 score
No cirrhosis	7.8 (5.6-10.9)	1.00				1.00
6	6.6 (2.9-14.6)	1.18 (0.48-2.86)	0.718			1.13 (0.46-2.80)	0.790
7	12.1 (7.5-19.5)	1.68 (0.93-3.04)	0.083			1.51 (0.81-2.82)	0.191
8	16.2 (9.4-27.8)	3.06 (1.57-5.94)	0.001			2.77 (1.35-5.67)	0.005
≥ 9	18.0 (12.1-26.9)	3.29 (1.89-5.71)	< 0.001			2.97 (1.68-5.27)	< 0.001
ALBI grade
1	9.2 (7.1-11.8)	1.00						1.00
≥ 2	15.2 (10.8-21.4)	2.24 (1.43-3.52)	< 0.001					2.02 (1.27-3.21)	0.003
Tumour factors
Aetiology of HCC
HBV	8.8 (6.3-12.4)	1.00		1.00		1.00		1.00		1.00
HCV	14.6 (10.5-20.3)	1.75 (1.08-2.81)	0.022	1.22 (0.73-2.03)	0.448	1.18 (0.70-1.99)	0.532	1.45 (0.89-2.35)	0.132	1.20 (0.72-1.99)	0.478
MASLD/ETOH	9.6 (6.5-14.1)	1.27 (0.74-2.17)	0.378	0.91 (0.51-1.62)	0.758	0.85 (0.48-1.53)	0.595	0.99 (0.56-1.73)	0.966	0.87 (0.49-1.55)	0.644
AFP (ng/mL)
< 400 (n = 190)	10.2 (8.1-12.8)	1.00
≥ 400 (n = 27)	15.7 (8.2-30.2)	1.53 (0.76-3.10)	0.234
BCLC
0-A	9.9 (7.9-12.3)	1.00		1.00		1.00		1.00		1.00
B-C	19.9 (11.8-33.7)	2.51 (1.41-4.47)	0.002	2.01 (1.12-3.60)	0.019	2.23 (1.23-4.03)	0.008	2.38 (1.33-4.25)	0.003	2.05 (1.15-3.67)	0.015
Number of nodules
1	10.3 (8.2-12.8)	1.00
2	13.9 (7.3-26.8)	1.77 (0.88-3.59)	0.112
≥ 3	13.5 (5.6-32.3)	1.45 (0.59-3.60)	0.418
Size of largest nodule/s
< 3 cm	8.1 (5.9-11.3)	1.00
3-4.9 cm	11.0 (7.5-16.1)	1.50 (0.90-2.49)	0.118
5-10 cm	17.2 (11.7-25.3)	2.67 (1.58-4.52)	< 0.001
> 10 cm	11.9 (5.0-28.6)	1.87 (0.73-4.82)	0.195
Presence of macroscopic vascular invasion (or tumour rupture/bleed)
No	10.3 (8.4-12.7)	1.00
Yes	26.8 (11.2-64.4)	2.96 (1.19-7.39)	0.020

Univariate and multivariate Cox proportional hazards regression analyses evaluating factors associated with recurrence following curative-intent liver resection. Results are presented as hazard ratios with 95% confidence intervals. AFP: Alpha-fetoprotein; ALBI: Albumin-bilirubin grade; BCLC: Barcelona Clinic Liver Cancer; CP: Child-Pugh score; MELD: Model for end-stage liver disease; HR: Hazard ratio; HCV: Hepatitis C virus; MASLD: Metabolic dysfunction-associated steatotic liver disease; ETOH: Chronic ethanol; HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma; MELD: Model for end-stage liver disease; T2DM: Type 2 diabetes mellitus.