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Background  Comparison of patterns of early hepatocellular carcinoma (HCC) recurrence beyond the Milan criteria (HRBM) and identification of the independent risk factors of time to recurrence beyond the Milan criteria (TRBM) after resection or ablation can develop an optimal first-line treatment and provide more opportunities and waiting time for salvage transplantation.    Methods  The patterns of HRBM after first-line resection or ablation in 384 patients with single-nodule HBV-associated HCC of 2–3 cm were retrospectively analyzed by one-to-one propensity score matching (PSM) between December 2008 and December 2017. The median TRBM between the resection group and the ablation group was estimated by Kaplan–Meier curves. The Cox regression analysis and binary logistic regression were used for the identification of the independent risk factors of TRBM and the occurrence of HRBM, respectively. The abilities of HRBM and the recurrence to predict overall survival (OS) were compared by the time-dependent receiver operating characteristic curves and estimated area under the curve.    Results  Of 384 patients enrolled in our study, 260 (67.7%) received resection (resection group) and 124 (32.3%) underwent ablation (ablation group). The median TRBM in the resection group was significantly longer than that in the ablation group before PSM (median, not available  vs . 101.4 months,  P  < 0.001) and after PSM (median, not available  vs . 85.7 months,  P  < 0.001). Cox regression showed ablation, older age, CRP ≥1.81 mg/L, and PLT ≤80 × 10 9 /L were the independent risk factors of TRBM. Binary logistic regression also showed that ablation, CRP ≥1.81 mg/L, and PLT ≤80 × 10 9 /L were the independent risk factors of the occurrence of HRBM. The incidences of various phenotypes of HRBM were not significantly different between the two groups, but the incidence of HRBM at the first recurrence in the ablation group was significantly higher than that in the resection group ( P  < 0.05). Besides, compared with recurrence, HRBM was a better predictor of OS ( P  < 0.05).    Conclusions  Compared with ablation, resection should be considered as a more appropriate first-line option for patients with single-nodule HBV-associated HCC of 2–3 cm and a more promising bridge for liver transplantation in those patients.

Recurrence Beyond the Milan Criteria of HBV-Related Single Hepatocellular Carcinoma of 2–3 cm: Comparison of Resection and Ablation