AIM:To investigate the clinicopathological riskfactors for immediate post-operative fatal recurrenceof hepatocellular carcinoma (HCC),which may havepractical implication and contribute to establishinghigh risk patients for pre-or post-operative preventivemeasures against HCC recurrence.METHODS:From June 1994 to May 2004,269 patientswho received curative resection for HCC were reviewed.Of these patients,those who demonstrated diffuse intra-hepatic or multiple systemic recurrent lesions within 6mo after surgery were investigated (fatal recurrencegroup).The remaining patients were designated as thecontrol group,and the two groups were compared forclinicopathologic risk factors.RESULTS:Among the 269 patients reviewed,30patients were enrolled in the fatal recurrence group.Among the latter,20 patients showed diffuse intra-hepatic recurrence type and 10 showed multiple systemicrecurrence type.Multivariate analysis between the fatalrecurrence group and control group showed that pre-operative serum alpha-fetoprotein (AFP) level wasgreater than 1000 μg/L (P=0.02; odds ratio=2.98),tumor size greater than 6.5 cm (P=0.03; OR=2.98),and presence of microvascular invasion (P=0.01;OR=4.89) were the risk factors in the fatal recurrencegroup.The 48.1% of the patients who had all the threerisk factors and the 22% of those who had two riskfactors experienced fatal recurrence within 6 mo aftersurgery.CONCLUSION:Three distinct risk factors for immediatepost-operative fatal recurrence of HCC after curativeresection are pre-operative serum AFP level>1000 μg/L, tumor size>6.5 cm,and microvascular invasion.Thehigh risk patients with two or more risk factors should bethe candidates for various adjuvant clinical trials. AIM: To investigate the clinicopathological risk factors for immediate post-operative fatal recurrence of hepatocellular carcinoma (HCC), which may have practical implications and contribute to establishing high risk patients for pre-or post-operative preventive measures against HCC recurrence. METHODS: From June 1994 to May 2004 , 269 patientswho received curative resection for HCC were reviewed. Of these patients, those who were diffuse intra-hepatic or multiple systemic recurrent lesions within 6mo after surgery were investigated (fatal recurrencegroup). The remaining patients were designated as the control group, and the two groups were compared for clinicopathologic risk factors. RESULTS: Among the 269 patients reviewed, 30 patients were enrolled in the fatal recurrence group. Among the latter, 20 patients showed diffuse intra-hepatic recurrence type and 10 showed multiple systemic blood flow type. Multivariate analysis between the fatal recurrence group and control group showed that pre-operative s (P = 0.02; odds ratio = 2.98), tumor size greater than 6.5 cm (P = 0.03; OR = 2.98), and presence of microvascular invasion ; OR = 4.89) were the risk factors in the fatal recurrence group. 48.1% of the patients who had all the threerisk factors and the 22% of those who had two riskfactors experienced fatal recurrence within 6 months aftersurgery. CONCLUSION: Three distinct risk factors for immediate post-operative fatal recurrence of HCC after curative resection are pre-operative serum AFP level> 1000 μg / L, tumor size> 6.5 cm, and microvascular invasion. high risk patients with two or more risk factors should be the candidates for various adjuvant clinical trials .