BackgroundTumour necrosis is linked to worse outcomes in hepatocellular carcinoma (HCC). However, the relationship between the extent of necrosis in HCC and survival outcomes remains unclear, partly due to the lack of a standardised assessment method. This study evaluated the prognostic significance of both the presence and extent of tumour necrosis.MethodsThis retrospective study included 96 HCC patients from two Finnish centres, treated with surgical resection from 1986 to 2022. The presence of necrosis (yes/no) was evaluated. The extent of necrosis was also assessed using three methods: (1) The average percentage method (proportion of necrosis relative to total tumour area), (2) the hotspot method (proportion of necrosis within a 2 mm hotspot), and (3) the linear method (diameter of the largest necrotic focus).ResultsTumour necrosis was associated with worse 5-year overall (HR 2.80, 95% CI 1.26–6.22, P = 0.011) and disease-specific survival (HR 3.89, 95% CI 1.45–10.47, P = 0.007). Tumours with low (but nonzero) necrosis level, as measured by the average percentage, hotspot, and linear methods, were linked to poorer survival outcomes compared to tumours without necrosis.ConclusionTumour necrosis is associated with poorer overall and disease-specific survival in resected HCC. The extent of necrosis did not correlate linearly with survival, highlighting the need for further research to refine its prognostic value.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-026-16040-z.
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