Preoperative predictors of early recurrence of AJCC T4 hepatocellular carcinoma

The management of HCC differs depending on the extent of disease. Surgery may be offered in selected cases of T4 disease as defined by AJCC 8th. However, outcome data post partial hepatectomy (PH) for T4 disease is scarce. We sought to evaluate the outcomes of patients post resection of T4 HCC and assess preoperative predictive factors of early recurrence. We performed a retrospective review of 235 consecutive patients who underwent resection for T4 HCC from 2001 to 2018 at our institution. Median overall survival was 35.9 months (95% CI 25.7–46.0). 109 patients (49.5%) developed recurrence, of which 94 patients (42.7%) experienced early recurrence within 12 months. Median time to recurrence was 38.1 months. Multivariate analysis demonstrated that vascular invasion were significant independent preoperative predictor of early recurrence post resection. Patients who experienced early recurrence had a significantly shorter median overall survival 14.3 months (95% CI 25.7–46.0) compared to those who did not (55.5 months, 95% CI 40.6–70.8, p = .000). Selected patients with T4 HCC may benefit from PH. Macrovascular invasion was associated with early recurrence within 12 months. •Surgery may be offered in selected cases of T4 HCC, but outcome data is presently scarce.•We reviewed 235 patients post hepatectomy for T4 HCC and found median overall survival to be 35.9 months.•Macrovascular invasion was associated with early recurrence of T4 HCC post hepatectomy. Synopsis: Surgery may be offered in selected cases of T4 HCC, but the outcome data is presently scarce. We reviewed 235 patients post hepatectomy for T4 HCC and found median overall survival to be 35.9 months, with macrovascular invasion associated with early recurrence.