Background: Several factors have been identified as predictors of recurrence following HCC treatment. Vascular invasion, tumor size and number also correlate with recurrence risk, with larger and multiple tumors associated with higher recurrence rates. Present study aims to study predicting factors for hepatocellular carcinoma recurrence from radiological features and tumor morphology. Material and Methods: Present study was cross-sectional study, conducted in adult patients (age ≥ 18 years) with histopathologically confirmed HCC, underwent liver transplant or curative liver resection, clinical, imaging, and laboratory data available during follow-up. Results: The mean age of patients is 57.5 ± 12.3 years. Tumor diameter is significantly larger in the metastasis group (5.2 cm vs. 3.8 cm, p=0.01), and tumor number is also higher (2.5 vs. 1.6, p=0.01), indicating tumor burden correlates with metastatic spread. Liver function assessed by MELD (4.8 vs. 3.0, p=0.02), CHILD score (2.5 vs. 2.0, p=0.03), and total bilirubin (2.8 vs. 2.1, p=0.04) are significantly worse in the metastasis group. The NLR is higher (4.5 vs. 3.9, p=0.01), supporting systemic inflammation’s role in metastasis. Microvascular invasion (55.6% vs. 26.3%, p=0.01) and macrovascular invasion (44.4% vs. 11.3%, p=0.01) are markedly higher in patients with metastasis, indicating vascular invasion as a key metastatic facilitator. Recurrence is more frequent among metastasis cases (66.7% vs. 45.1%, p=0.02). Capsular integrity and cirrhosis rates do not differ significantly. Tumor differentiation shows no significant difference. Necrosis on CT and histopathology is significantly more common in metastatic patients (44.4% vs. 22.6%, p=0.01 and 55.6% vs. 33.8%, p=0.02, respectively), suggesting necrosis may relate to aggressive tumor phenotype and metastatic potential. Conclusion: Tumor size, tumor number, vascular invasion, liver function, and systemic inflammation are key predictors of post-transplant or post-resection recurrence and extrahepatic metastasis in hepatocellular carcinoma.

vascular invasion, liver function, post-transplant recurrence, extrahepatic metastasis, hepatocellular carcinoma.