Recurrence rate, features, and outcome after hepatocellular carcinoma curative resection or ablation according to the IMbrave050 criteria: a real-world study

Background/Aims: Adjuvant systemic therapy has been proposed in patients at high-risk of hepatocellular carcinoma (HCC) recurrence. This study assessed the outcomes of a real-world cohort treated with either resection or ablation, stratified according to the IMbrave050 trial criteria. Methods: We selected, from the Italian Liver Cancer database, 1150 patients with HCC treated with upfront resection (n = 483, 64.2 % high-risk) or ablation (n = 667, 49.6 % high risk), fulfilling the inclusion criteria of the IMbrave050 trial. Results: Median recurrence-free survival (RFS) was shorter in high-risk resected patients (29.0 vs. 43.0 months; p = 0.024), while no difference was observed after ablation (27.0 vs. 30.0 months; p = 0.098). Recurrence was borderline higher in high-risk resected patients [Hazard Ratio (HR) 1.26, 0.97–1.23; p = 0.052], but not ablated ones (HR 1.13, 0.92–1.38; p = 0.221). Independent predictors of recurrence were cirrhosis (HR 1.52, 1.13–2.05), multinodular HCC (HR 1.31, 1.14–1.52), and microvascular invasion (HR 1.39, 1.05–1.83) in resected, and alpha-fetoprotein (HR 1.15, 1.07–1.23) in ablated patients. Median overall survival was similar in resected risk-groups (147.0 vs. 130.0 months; p = 0.093), shorter in high-risk ablated patients (79.0 vs. 98.0 months; p = 0.021). Conclusions: The criteria used to assess HCC recurrence risk in the IMbrave050 trial find validation by real-world data in patients treated with resection, while they are inaccurate after ablation.