Background: High recurrence rates after liver resection with curative intent for hepatocellular carcinoma (HCC) remain a problem. The characterization of long-term survivors without recurrence after liver resection may help improve the therapeutic strategy for HCC. Methods: A nationwide Japanese database was used to analyse 20 811 patients with HCC who underwent liver resection with curative intent. Results: The 10-year recurrence-free survival rate after liver resection for HCC with curative intent was 22·4 per cent. Some 281 patients were recurrence-free after more than 10 years. The HCCs measured less than 5 cm in 83·2 per cent, a single lesion was present in 91·7 per cent, and a simple nodular macroscopic appearance was found in 73·3 per cent of these patients; histologically, most HCCs showed no vascular invasion or intrahepatic metastases. Multivariable analysis revealed tumour differentiation as the strongest predictor of death from recurrent HCC within 5 years. Conclusion: Long-term recurrence-free survival is possible after liver resection for HCC, particularly in patients with a single lesion measuring less than 5 cm with a simple nodular appearance and low tumour marker levels.
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