Long-Term Analysis of Recurrence Beyond Milan Criteria Following Ablation of Solitary Early-Stage Hepatocellular Carcinoma ≤3 cm in Potentially Transplantable Patients: A Over 10-Year Survival Study.

Background: Salvage liver transplantation is promising for hepatocellular carcinoma(HCC) recurrence post-ablation but is significantly affected by recurrence beyond Milan Criteria (RBM). Materials and Methods: A retrospective cohort study of potentially transplantable HCC patients undergoing ablation between 2007 and 2017 assessed median time to recurrence beyond Milan Criteria(TRBM) via Kaplan-Meier curves and predictive capacity of recurrence and RBM for overall survival(OS) via Receiver Operating Characteristic Curves, and identified independent risk factors for TRBM and RBM via Cox and binary logistic regression models. Results: We enrolled 191 potentially transplantable patients with early-stage HBV-related HCC ≤3 cm who underwent ablation. During a median follow-up of 7.64 years, HCC recurrence occurred in 126 patients(65.9%), with RBM 86 patients(45.0%). The median TRBM was 10.54 years. Cumulative survival rates without RBM at 3, 5, 8, 10, and 13 years were 77.3%, 65.9%, 56.5%, 51.0%, and 37.6%, respectively. Multivariable analysis identified older age, C-reactive protein(CRP)≥1.81 mg/L, and platelet(PLT)≤80×10 Conclusion: When using ablation as a bridge to liver transplantation for solitary HBV-related early HCC (≤3 cm), it is crucial first to identify key preoperative features, including high CRP, low PLT, cirrhosis, and older age.