Real-World Study of Post-Recurrence Treatment Strategies for Microvascular Invasion-Positive Hepatocellular Carcinoma After Curative Resection.

Introduction: Optimal treatment for recurrent hepatocellular carcinoma (HCC) after curative resection remains unclear, particularly in patients with microvascular invasion (MVI). This study evaluated post-recurrence treatment patterns and survival outcomes in this population. Methods: We retrospectively included patients with MVI-positive HCC who developed recurrence after curative hepatectomy at a single center. Post-recurrence progression-free survival (PFS) was the primary endpoint and overall survival (OS) was the secondary endpoint. Kaplan-Meier analysis was used to compare survival across post-recurrence treatment groups. Cox regression, subgroup analysis, propensity score matching, and correlation analysis between recurrence-free survival (RFS) and post-recurrence PFS were also performed. Results: A total of 150 patients were included, and 132 received post-recurrence treatment. Treatment strategies were heterogeneous, with locoregional therapy plus tyrosine kinase inhibitor (TKI) and immune checkpoint inhibitor (ICI), surgery-based therapy, locoregional therapy plus TKI, and locoregional therapy alone being the main approaches. Median PFS and OS were 10.4 and 26.7 months, respectively. Survival outcomes differed across treatment groups in the unadjusted analysis. Patients receiving surgery-based therapy showed more favorable PFS and OS than those receiving locoregional therapy alone, although this finding should be interpreted cautiously given the non-randomized treatment allocation and potential baseline imbalances among treatment groups. In exploratory multivariable analysis, locoregional therapy plus TKI, locoregional therapy plus TKI and ICI, and surgery-based therapy were associated with longer PFS, whereas no treatment regimen was independently associated with OS. Among patients with potentially resectable recurrence, surgery-based therapy showed numerically more favorable outcomes before matching. However, the differences were not statistically significant and became less apparent after propensity score matching. Conclusion: Post-recurrence management in MVI-positive HCC after curative resection was highly heterogeneous. Surgery-based therapy was associated with favorable outcomes in selected patients, but this association may have been influenced by recurrence pattern and patient selection. Locoregional therapy combined with systemic treatment may be considered a clinically relevant option for non-surgical candidates, although its comparative effectiveness requires further validation.