BACKGROUND : Survival after liver resection of hepatocellular carcinoma (HCC) remains poor because of a high incidence of recurrence. We sought to investigate risk factors, patterns, and long-term prognosis among patients with early and late recurrence after liver resection for hepatitis B virus (HBV)-associated HCC.

METHODS : Data of consecutive patients undergoing curative resection for HBV-associated HCC were analyzed. According to the time to recurrence after surgery, recurrence was divided into early (≤2 years) and late recurrence (>2 years). Characteristics, patterns of initial recurrence, and postrecurrence survival (PRS) were compared between patients with early and late recurrence. Risk factors of early and late recurrence and predictors of PRS were identified by univariable and multivariable Cox regression analyses.

RESULTS : Among 894 patients, 322 (36.0%) and 282 (31.5%) developed early and late recurrence, respectively. On multivariable analyses, preoperative HBV-DNA >104 copies/mL was associated with both early and late recurrence, whereas postoperative no/irregular antiviral therapy was associated with late recurrence. Compared with patients with late recurrence, patients with early recurrence had a lower proportion of intrahepatic-only recurrence (72.0% vs. 91.1%, p < .001), as well as a lower chance of receiving potentially curative treatments for recurrence (33.9% vs. 50.7%, p < .001) and a worse median PRS (19.1 vs. 37.5 months, p < .001). Multivariable analysis demonstrated that early recurrence was independently associated with worse PRS (hazard ratio, 1.361; 95% confidence interval, 1.094-1.692; p = .006).

CONCLUSION : Although risk factors associated with early recurrence and late recurrence were different, a high preoperative HBV-DNA load was an independent hepatitis-related risk for both early and late recurrence. Early recurrence was associated with worse postrecurrence survival among patients with recurrence.

IMPLICATIONS FOR PRACTICE : Liver resection is the mainstay of curative treatment for hepatocellular carcinoma (HCC), but survival after resection remains poor because of high incidence of recurrence. We investigated the risk factors, patterns, and long-term prognosis among patients with early and late recurrence and found that although independent risk factors associated with early and late recurrence were different, a high preoperative hepatitis B virus (HBV) DNA load was an independent hepatitis-related risk for both of them. In addition, early recurrence was also demonstrated to be independently associated with worse postrecurrence survival among patients with recurrence. Data from the current study may provide insights into different biological origin and behavior of early versus late recurrence after liver resection for HBV-associated HCC, which could be helpful to inform decision making about treatment options for recurrent HCC, as well as rational strategies for recurrence surveillance after HCC resection.