DISCUSSION
cirrhotic leftover liver, tumor, HCC
PRIMARY TUMOR, TUMOR, RECURRENCE, METASTASIS
To date, long‐term postoperative outcomes of HCC remain unsatisfactory owing to the multiplicity of recurrence patterns. EHR, although its incidence is lower than that of intrahepatic recurrence, often leads to a worse prognosis.Contrary to intrahepatic recurrence, which can either be a multicentric tumor developing de novo in the cirrhotic leftover liver or metastasis from the primary tumor, dissemination from the primary tumor preoperatively is the main reason for EHR.In addition to preoperative CTC status, multivariate analyses in this study also revealed that large tumor size (>5 cm), multi‐nodule number (>3), and MVI status were risk factors in postoperative EHR. These findings are consistent with those of numerous studies,This study had some limitations. First, all patients in the study came from a single center and the sample size was relatively small; therefore, there may be some bias in the statistical analysis. An external validation cohort in a multicenter study is needed in future studies to make the results more convincing. Second, this study was performed only at the clinical level, and the source of CTC counts was targeted only for patients with preoperative peripheral blood samples. Further studies on the molecular mechanisms are needed to elucidate the possible mechanisms underlying the influence of CTC notation on extrahepatic metastasis in patients with HCC.