Objective: The aim of this study was to clarify the predictive factors of recurrence-free time more than 10 years after primary hepatic resection for hepatocellular carcinoma (HCC). Summary of background data: Surgical resection is a curative treatment for HCC patients with hepatic functional reserve; however, the high recurrence rate must be addressed. Methods: The study included 595 patients who had undergone curative resection for HCC. Multivariate analysis was performed to identify factors associated with recurrencefree survival at more than 10 years. Results: Multivariate analysis revealed that tumor size ≥2 cm (P = 0.004), albuminbilirubin (ALBI) grade 1 (P = 0.03), Fibrosis-4 (FIB-4) index ≥3.3 (P = 0.002), and histologic inflammation grade ≥1 (P = 0.03) were independent predictive factors for recurrence-free survival for more than 10 years. Predictive points were scored as follows: 2 points, tumor size ≥2 cm or FIB-4 index ≥3.3; and 1 point, ALBI grade 1 or histologic inflammation grade ≥1. Patients were divided into 3 groups according to their total points: group 1, 0 to 2 points (n=317); group 2, 3 to 4 points (n=239); and group 3, 5 to 6 points (n=39). Recurrence-free survival rates among the 3 groups were significantly different (P , 0.0001). Conclusions: Tumor size, ALBI, FIB-4 index, and histologic inflammation grade were independent predictive factors for recurrence-free survival longer than 10 years after curative hepatic resection for HCC.
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