Treatment Strategy for Post-Hepatectomy Recurrent Hepatocellular Carcinoma: A Single Center Experience with 556 Consecutive Cases in China

Background: Treatment strategy for recurrent hepatocellular carcinoma (HCC) remains\r\nscantily defined. This study was aimed to establish a treatment strategy to\r\nmanage post-hepatectomy recurrent HCC and report the clinical outcomes. Methods: From January 2006 to December 2016, 556 consecutive patients who developed\r\npost-hepatectomy HCC recurrence were enrolled in the study. The patients were\r\nclinically stratified and treated according to a strategy established by a\r\nmulti-disciplinary team. Clinical data and survival times were collected\r\nprospectively and analyzed retrospectively. Results: According to the\r\nstrategy, there were 298 (53.6%), 214 (38.5%), 32 (5.7%) and 12 (2.2%) patients\r\nstratified into Early, Intermediate, Advanced and Terminal stages,\r\nrespectively. In Early stage patients, 164 (55.0%) received curative treatment\r\nin the form of repeat resection or local ablation, 134 (45.0%) received\r\ntransarterial chemoembolization (TACE), and\r\nthe 1-, 3-, and 5-year overall survival (OS) rates were 82.0%, 46.8% and 37.3%,\r\nrespectively. In Intermediate stage patients, 207 (96.7%) received TACE, 7 (3.3%)\r\nradiotherapy, and the 1-, 3-, and 5-year OS rates were 73.2%, 31.8% and 15.9%, respectively.\r\nIn Advanced stage patients, 22 patients received sorafenib, 10 radiotherapy,\r\nand the mean survival time (MST) was 25.1 ± 3.1 months. All the 12 patients in Terminal\r\nstage received the best supportive treatment, and the MST was 6.5 ± 3.4\r\nmonths. Clinical stages and duration of disease-free interval were independent\r\nfactors relating to overall survival. Conclusions: A treatment strategy\r\nderived from the Barcelona Clinic Liver Cancer staging system, with some\r\nmodifications, has been successfully established to manage post-hepatectomy\r\nrecurrent HCC, and the clinical outcomes were commendable.