当前使用的治疗算法最初是基于原发性肝细胞癌（HCC）的初次治疗临床结果建立的，目前没有强有力的证据表明这些算法也适用于手术后复发的患者。因此，该研究旨在探索复发性HCC患者的最佳风险分层方法，以便更好地进行临床管理。研究详细检查了1616名接受根治性切除术的HCC患者中983名发生复发的患者的临床特征和生存结果。多元分析确认了前一次手术的无病生存期（DFI）和复发时的肿瘤分期均为重要的预后因素。然而，DFI的预后影响似乎根据肿瘤复发时分期的不同而有所差异。虽然根治性治疗对于复发时分期为0或A期的患者生存率有很强的影响（危险比[HR]，0.61；P<0.001），但对于分期为B期的患者，早期复发（<6个月）则是一个较差的预后标志。分期为C期的患者的预后仅受肿瘤分布或治疗选择的影响，而与DFI无关。DFI是预测复发性HCC肿瘤学行为的一种补充性指标，其预测价值取决于肿瘤复发时的分期。这些因素应考虑在选择根治性手术后复发HCC患者的最佳治疗方案时。 © 2023年。外科肿瘤学会。

Currently used treatment algorithms were originally established based on the clinical outcomes of the initial treatment for primary hepatocellular carcinoma (HCC), and no strong evidence exists yet to suggest if these algorithms could also be applicable to patients with recurrent HCC after surgery. As such, this study sought to explore an optimal risk stratification method for cases of recurrent HCC for better clinical management.Among the 1616 patients who underwent curative resection for HCC, the clinical features and survival outcomes of 983 patients who developed recurrence were examined in detail.Multivariate analysis confirmed that both the disease-free interval (DFI) from the previous surgery and tumor stage at recurrence were significant prognostic factors. However, the prognostic impact of DFI seemed different according to the tumor stages at recurrence. While curative-intent treatment showed strong influence on survival [hazard ratio (HR), 0.61; P < 0.001] regardless of the DFI in patients with stage 0 or stage A disease at recurrence, early recurrence (< 6 months) was a poor prognostic marker in patients with stage B disease. The prognosis of patients with stage C disease was exclusively influenced by the tumor distribution or choice of treatment than by the DFI.The DFI complementarily predicts the oncological behavior of recurrent HCC, with its predictive value differing depending on the tumor stage at recurrence. These factors should be considered for selection of the optimal treatment in patients with recurrent HCC after curative-intent surgery.© 2023. Society of Surgical Oncology.