Objective:  The aim of this study was to clarify the predictive factors of recurrence-free time more than 10 years after primary hepatic resection for hepatocellular carcinoma (HCC).Summary of Background data:  Surgical resection is a curative treatment for HCC patients with hepatic functional reserve; however, the high recurrence rate must be addressed.Methods:  The study included 595 patients who had undergone curative resection for HCC. Multivariate analysis was performed to identify factors associated with recurrence-free survival more than 10 years.Results:  Multivariate analysis revealed that tumor size ≤2 cm ( P  = 0.004), ALBI grade 1 ( P  = 0.03), FIB-4 index ≤3.3 ( P = 0.002), and histological inflammation grade ≤1 ( P  = 0.03) were independent predictive factors for recurrence-free survival for more than 10 years. Predictive points were scored as follows: 2 points, tumor size ≤2 cm or FIB-4 index ≤3.3, and 1 point, ALBI grade 1 or histological inflammation grade ≤1. Patients were divided into three groups according to their total points: Group 1, 0–2 points (n = 317); Group 2, 3–4 points (n = 239); and Group 3, 5–6 points (n = 39). Recurrence-free survival rates among the three groups were significantly different ( P  <0.0001). Conclusions:  Tumor size, ALBI, FIB-4 index, and histological inflammation grade were independent predictive factors for recurrence-free survival longer than 10 years after curative hepatic resection for HCC.

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