Treatment Strategy for Post-hepatectomy Recurrent Hepatocellular Carcinoma Within the Milan Criteria: Repeat Resection, Local Ablative Therapy or Transarterial Chemoembolization?

The results of treatment for early stage recurrent hepatocellular carcinoma (HCC) remain controversial. This study aimed to analyze the clinical outcomes of recurrent HCC within the Milan criteria following different treatment modalities except liver transplantation. From January 2006 to December 2016, 272 consecutive HCC patients who developed intrahepatic recurrence after hepatectomy that satisfied the Milan criteria and Child–Pugh class A or B liver function were retrospectively enrolled. The outcomes of repeat resection (RR), local ablative therapy (LAT), or transarterial chemoembolization (TACE) were reported, and the prognostic factors of survival were investigated. Among the 272 patients, 136 (50.0%), 71 (26.1%), and 65 (23.9%) received TACE, LAT, and RR treatments, respectively. Treatment-related complications were 9.5%, 11.3%, and 10.7%, respectively, in the three groups. No patient died of treatment-related complication. The 1-, 3-, and 5-year overall survival rates after recurrence were 95.0%, 54.2%, and 45.8%, respectively, in the RR group; 86.6%, 51.7%, and 42.4%, respectively, in the LAT group; and 77.2%, 46.5%, and 38.4%, respectively, in the TACE group. On multivariate analysis, three independent factors related to survival after recurrences were identified. A single tumor nodule and AFP < 200 ng/mL predicted better survival, while a disease-free interval ≤ 1 year was associated with poor outcomes. RR and LAT could achieve good survival outcomes in well-selected patients with recurrent HCC within the Milan criteria, while TACE was the main form of treatment when curative therapy was not considered feasible and the clinical outcomes were satisfactory.