Prognostic Determinants and Treatment Strategies Associated with Long-Term Survival in Early-Stage Hepatocellular Carcinoma: A Retrospective Cohort Study.

Purpose: Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality worldwide and is particularly prevalent in Taiwan. While curative treatments offer favorable outcomes for early-stage HCC, prognostic factors change and option medical strategy remain uncertain in long term survival early-stage HCC. Patients and Methods: This retrospective study analyzed 1144 patients with BCLC stage 0 or A HCC from a cancer registry (2011-2020) followed through 2023. Prognostic factors were evaluated using Cox regression. Subgroup analyses were performed on patients who survived over five years, and further stratified into 5-10 years and >10 years survival groups to assess treatment outcomes and tumor-free status (TFS). Results: Age >65, Child-Pugh B, and non-curative treatment were consistent poor prognostic factors; HBV-related HCC was associated with improved survival. Among patients surviving >10 years, higher TFS rates and lower stage progression were observed compared to those surviving 5-10 years. Curative treatment significantly increased the likelihood of achieving TFS (p = 0.044). Conclusion: Long-term survival in early-stage HCC is influenced by age, liver function, viral etiology, and treatment strategy. Curative treatments significantly improve outcomes, and maintaining curative treatment options is crucial for patients who experience recurrence while still in the early stage of HCC.