BACKGROUND: Patients with recurrent hepatocellular carcinoma after liver resection can often receive curative treatment, including repeat hepatic resection and local ablative therapy. However, recurrence typically becomes increasingly aggressive during the clinical course, characterized by cycles of recurrence and repeated treatment, ultimately resulting in noncurative patterns. METHODS: Noncurative recurrence was defined as the presence of ≥4 liver nodules, macroscopic vascular invasion, and extrahepatic lesions. First, this study investigated the incidence of noncurative recurrence and survival after noncurative recurrence. Subsequently, this study examined survival after the initial recurrence in patients with curative and noncurative recurrences and compared them. Finally, this study investigated whether the time to noncurative recurrence serves as a surrogate for overall survival (OS) in 266 patients who underwent initial curative hepatectomy. RESULTS: The 3-year cumulative incidences of noncurative recurrence were 15.6%, 6.0%, and 11.0% for ≥4 liver nodules, macroscopic vascular invasion, and extrahepatic lesions, respectively. The median postrecurrence survival estimates after these noncurative recurrences were 21, 17, and 8 months, respectively (P =.006). When analyzed exclusively in patients developing initial recurrence, the 3-year postrecurrence survival rates were 68.3% and 27.8% for patients with curative and noncurative recurrences, respectively (P =.003). The 3-year survival rate without noncurative recurrences was 71.9%, and the recurrence-free survival (RFS) and OS rates were 49.2% and 87.9%, respectively. The concordance index with OS was higher for time to noncurative recurrence than for RFS (0.88 vs 0.67, respectively). CONCLUSION: Our findings suggest that the time to noncurative recurrence is a more suitable surrogate for OS than RFS.