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. (c) 2025 The Author(s). Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)