Liver Parenchymal Quality Predicts Outcomes After HCC Resection: Liver Transplantation | July 2026

Introduction:

Hepatic resection and liver transplantation are curative treatment options for hepatocellular carcinoma (HCC). While patients undergoing resection are often classified simply as cirrhotic or noncirrhotic, many noncirrhotic patients have underlying parenchymal abnormalities that may influence long-term outcomes. This study evaluated whether liver parenchymal quality provides additional prognostic information following hepatic resection for HCC.

Why was this study needed?

Noncirrhotic HCC patients are frequently considered a homogeneous group despite varying liver pathology.

The prognostic impact of diseased noncirrhotic liver parenchyma remains poorly defined.

Better risk stratification could improve surgical decision-making and postoperative surveillance.

Comparing resection outcomes with liver transplantation provides a benchmark for curative treatment.

Results:

This retrospective multicenter study analyzed 380 patients undergoing curative-intent hepatic resection and stratified them according to the histology of the non-tumorous liver into normal, diseased noncirrhotic, and cirrhotic groups. Patients with histologically normal liver achieved significantly better long-term survival than those with either cirrhotic or diseased noncirrhotic parenchyma. In contrast, outcomes were similar between the diseased noncirrhotic and cirrhotic groups, indicating that underlying liver injury adversely affects prognosis even in the absence of established cirrhosis. Both cirrhosis and diseased noncirrhotic liver independently predicted reduced overall survival and increased recurrence risk. As expected, the liver transplantation cohort demonstrated the most favorable long-term survival, serving as a benchmark for optimal oncologic outcomes.

Clinical Impact:

The findings challenge the traditional cirrhotic versus noncirrhotic classification used after hepatic resection for HCC. Histological assessment of the background liver should be incorporated into postoperative risk stratification, as patients with noncirrhotic but diseased liver may require surveillance and management strategies similar to those with cirrhosis. These data may also help refine patient selection when considering resection versus transplantation.

Bottom Line:

Background liver quality is a major determinant of outcomes after hepatic resection for HCC. Histologically normal liver identifies a distinct subgroup with excellent prognosis, whereas diseased noncirrhotic liver carries survival and recurrence risks comparable to cirrhosis.