Optimizing recurrent hepatocellular carcinoma treatment in Sweden: a nationwide cohort study
Meimene Khalil, Karin Johansen, Linda Lundgren, Kristina Hasselgren, Per Sandström, Bergthor BjörnssonAbstract
Introduction
Hepatocellular carcinoma (HCC) is the most common type of primary liver malignancy and has a high recurrence rate. The optimal treatment for recurrent HCC remains unclear. We conducted a retrospective nationwide cohort study to evaluate treatment patterns and survival outcomes for the management of recurrent HCC in Sweden, with a secondary objective of assessing morbidity associated with re-intervention.
Methods
Patients treated curatively for recurrent HCC between 2009 and 2024 were identified from the prospectively maintained Swedish National Registry for Tumours of the Liver and Bile Ducts (SweLiv). Overall survival was analyzed using the Kaplan-Meier and the log-rank test, and morbidity was compared using the chi-square test.
Results
A total of 468 patients with recurrent HCC were included. Overall survival did not differ significantly among curative treatment modalities, even for smaller recurrent tumours (<3 cm). Postoperative complications were more frequent after resection than after ablation. Patients undergoing ablation most frequently presented with small tumours ≤30 mm, whereas larger tumors (31–50 mm or >50 mm) were relatively more common among those treated with resection (P < 0.001). In multivariable analysis, older age (HR 1.03, P < 0.001) and extrahepatic recurrence (HR 2.83, P < 0.001) were independently associated with worse overall survival.
Discussion
Overall survival did not differ between curative treatments for recurrent HCC, highlighting the importance of offering ablative treatment whenever feasible. Older age and extrahepatic recurrence were associated with poorer survival, therefore detecting recurrence early is necessary to enable eligibility for ablative treatment.