Updates and advancements in the management of hepatocellular carcinoma patients after hepatectomy

ABSTRACT

Introduction: The 5-year recurrence rate of hepatocellular carcinoma (HCC) after hepatic resection or local ablation is up to 70%. Adjuvant therapies to prevent HCC recurrence have been reported but are not currently recommended by EASL or AASLD guidelines. This review examined evidence from randomized controlled trials, meta-analyses and systematic reviews on the safety and efficacy of adjuvant therapies and chemotherapies in HCC patients after resection or local ablation.

Areas covered: PubMed was searched through 15 June 2019. Available evidence was assessed based on the GRADE system.

Expert commentary: Transarterial chemoembolization is the best adjuvant therapy for HCC patients at high risk of recurrence, antiviral therapy with nucleoside analogs is effective for preventing recurrence of HBV-related HCC, and interferon-α is effective for preventing recurrence of HCV-related HCC. Further studies are needed to clarify the efficacy of adjuvant immune checkpoint inhibitors. Adjuvant sorafenib appears to offer negligible clinical benefit and high risk of adverse effects.

KEYWORDS:

• Adjuvant
• hepatocellular carcinoma
• hepatic resection
• tumor recurrence

Article highlights

• Postoperative nucleoside analog therapy is safe and effective to prevent recurrence in patients with HBV-related HCC in Asian.

• Postoperative adjuvant interferon-α is safe and effective to prevent recurrence in patients with HCV-infected HCC.

• Postoperative adjuvant TACE is safe and effective to prevent recurrence in patients at high risk of recurrence in Asian.

• Adjuvant adoptive immunotherapy is safe and effective to prevent HCC recurrence after surgery.

• Adjuvant sorafenib is not an effective therapy to prevent HCC recurrence after surgery.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the Graduate Course Construction Project of Guangxi Medical University (YJSA2017014), the Foundation Ability Enhancement Project for Young Teachers in Guangxi Universities (2018KY0122), the Guangxi Natural Science Foundation (2018GXNSFBA138018), and ‘Guangxi BaGui Scholars’ Special Fund.