To investigate the difference of postoperative recurrence-free survival and related risk factors between hepatitis B-associated hepatocellular carcinoma (HCC) patients complicated with and without liver cirrhosis.

Clinical data of 731 HCC patients who underwent radical hepatectomy in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2010 to December 2016 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 640 patients were male and 91 female, aged from 18 to 81 years, with a median age of 51 years. The tumor diameter was 0.7-21.0 cm, with a median diameter of 6.0 cm. According to the incidence of liver cirrhosis, all patients were divided into the cirrhosis (n=584) and non-cirrhosis group (n=147). Survival analysis was performed by Kaplan-Meier method and Log-rank test. The risk factors of postoperative tumor recurrence were identified by Cox regression model.

The follow-up time was 3-105 months, with a median of 58 months. During postoperative follow-up, 366 patients recurred, including 308 cases of intrahepatic recurrence, 55 cases of lung metastases and 73 cases of kidney, brain and bone metastases. Survival analysis revealed that the median recurrence-free survival of HCC patients complicated with and without cirrhosis was 14.5 and 23.3 months, respectively. The postoperative 1-, 3- and 5-year recurrence-free survival rates in the cirrhosis group were 57.1%, 37.8% and 29.9%, and 61.3%, 47.9% and 40.9% in the non-cirrhosis group, respectively, and the differences were statistically significant between two groups (χ²=4.469, P<0.05). Cox multivariate analysis showed that multiple tumor lesions, grade Ⅲ+Ⅳ differentiation and ascites were the independent risk factors for postoperative recurrence-free survival of HCC patients with liver cirrhosis (HR=1.55, 1.59, 1.70; P<0.05). AST≥35 U/L, multiple lesions and capsule-free tumors were the independent risk factors for postoperative recurrence-free survival of non-liver cirrhosis HCC patients (HR=2.26, 2.41, 0.41; P<0.05).

Hepatitis B-associated HCC patients complicated with liver cirrhosis are more prone to postoperative tumor recurrence compared with non-cirrhosis counterparts. The prognostic factors differ between the cirrhosis and non-cirrhosis groups. Multiple lesions are the common independent risk factors for postoperative recurrence-free survival oftwo groups.