ArticleJournal of gastrointestinal oncology2026
Daily increment of residual liver regeneration (DIRER) predicts tumor recurrence and mortality after radical hepatectomy for hepatocellular carcinoma.
Article in Journal of gastrointestinal oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death globally, with a 5-year recurrence rate of 70% even after curative resection. Liver regeneration following hepatectomy shares molecular mechanisms with tumor recurrence, yet the relationship between early liver regeneration and HCC recurrence remains unclear. This study aimed to investigate the association between the daily increment of residual liver regeneration (DIRER) and post-hepatectomy outcomes. Methods: A single-center, retrospective cohort study was conducted at the Eastern Hepatobiliary Surgery Hospital, including 324 patients who underwent R0 hepatectomy between 2017 and 2019, with complete preoperative and postoperative three-dimensional (3D) visualization data. Of these, 128 patients (39.5%) had underlying liver cirrhosis. Liver resection volume was assessed intraoperatively using the drainage method. The residual liver volume (RLV) to body weight ratio (RLVw) was calculated as the ratio of RLV to preoperative body weight. DIRER was defined as the daily increase in RLV during regeneration. Prognostic risk factors were identified using Cox regression, and optimal DIRER cut-off points for recurrence-free survival (RFS) and overall survival (OS) were determined via X-tile software. Kaplan-Meier curves assessed clinical significance, with interaction and stratified analyses based on tumor size and surgical resection range. Logistic regression was employed to identify predictors of DIRER. Results: DIRER was found to be an independent risk factor for both RFS [hazard ratio (HR) =1.06, P=0.003] and OS (HR =1.06, P=0.004). DIRER was also associated with early recurrence (HR =1.05, P=0.02). Higher DIRER was linked to a significantly higher risk of multiple recurrences [relative risk (RR) =1.83, P=0.02]. For tumors ≤5 cm, a larger surgical resection range was associated with higher recurrence rates (HR =1.95, P=0.02). Additionally, a lower RLVw was correlated with higher DIRER and worse prognosis. Conclusions: Excessive hepatectomy may accelerate liver regeneration, leading to earlier recurrence and poorer prognosis. This underscores the importance of careful preoperative planning to balance the extent of radical resection with adequate RLV.
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