title: Recurrent hepatocellular carcinoma: a Western strategy that emphasizes the impact of pathologic profile of the first resection.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) often recurs after curative resection, and thus the optimal treatment strategy to treat recurrences remains uncertain. We analyzed the results of different options to treat recurrent HCC and emphasized the impact of pathologic patterns of the tumor at initial resection.
  
  
  METHODS
  Between 2000 and 2014, 293 patients underwent potentially curative hepatic resection for HCC. Among them, 150 experienced a recurrence and have been treated by repeat resection (RR), radiofrequency ablation (RFA), salvage liver transplantation (SLT), transarterial chemoembolization (TACE), or conservative treatment, including systemic or targeted chemotherapy. Clinical outcomes were analyzed and compared between the treatment groups, focusing on clinical and pathologic characteristics of the tumor at initial resection.
  
  
  RESULTS
  After a median follow-up of 26 months, the overall survival (OS) at 1, 3, and 5 years after recurrence was 62%, 48%, and 40%, respectively. Survival rates were greater in patients treated by a curative approach (RR, RFA, SLT) than those treated by TACE, with 5-year OS of >70% and 37%, respectively. Univariate analysis showed satellitosis and microvascular invasion (MVI) at initial resection as negative prognostic factors of survival after recurrence (P < .05). On multivariate analysis, type of treatment was the only independent factor associated with survival. A subgroup analysis showed that RR/RFA led to better survival outcomes than TACE for early stage intrahepatic recurrences in the absence of satellitosis or MVI on the primary resected tumor.
  
  
  CONCLUSIONS
  Curative treatments of recurrent HCC improve patient survival. Satellitosis and MVI on the primary resected specimen may be used as selection criteria for the best treatment strategy for intrahepatic recurrences.
authors: Departments of Hepato-biliary Surgery and Liver Transplantation, Hôpital Saint-Antoine, Paris, France; Université Pierre-Marie Curie, Paris VI, Paris, France.
authors: Roberto L
authors: RL
authors: Meniconi
authors: Departments of Hepato-biliary Surgery and Liver Transplantation, Hôpital Saint-Antoine, Paris, France.
authors: Shohei
authors: S
authors: Komatsu
authors: Departments of Hepato-biliary Surgery and Liver Transplantation, Hôpital Saint-Antoine, Paris, France; Université Pierre-Marie Curie, Paris VI, Paris, France.
authors: Fabiano
authors: F
authors: Perdigao
authors: Biostatistics and Public Health, Hôpital Saint-Antoine, Paris, France; Université Pierre-Marie Curie, Paris VI, Paris, France.
authors: Pierre-Yves
authors: PY
authors: Boëlle
authors: Departments of Hepato-biliary Surgery and Liver Transplantation, Hôpital Saint-Antoine, Paris, France; Université Pierre-Marie Curie, Paris VI, Paris, France.
authors: Olivier
authors: O
authors: Soubrane
authors: Departments of Hepato-biliary Surgery and Liver Transplantation, Hôpital Saint-Antoine, Paris, France; Université Pierre-Marie Curie, Paris VI, Paris, France. Electronic address: olivier.scatton@sat.aphp.fr.
authors: Olivier
authors: O
authors: Scatton
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*