After radical resection of hepatocellular carcinoma, the recurrence rates at 1, 3 and 5 years are 17%, 32% and 61%, respectively, and the peak recurrence period is 2 to 3 years after surgery.
Postoperative recurrence is a key factor that seriously affects patients’ long-term survival, and whether it can be detected early directly affects the choice and efficacy of subsequent therapies.
Liver transplantation
Liver transplantation is more effective than other treatments, including surgical resection, in the following 3 situations.
- More recurrent lesions, >3;
- Patients with a combination of more severe cirrhosis that cannot tolerate surgical resection, radiofrequency, etc.
- Imaging shows a highly aggressive tumor without major portal vein branches or hepatic vein invasion.
Surgical resection
Surgical resection is currently recognized nationally and internationally as the second most effective treatment after liver transplantation. Surgical resection is preferred if the recurrent foci are less than or equal to 3 and the remaining liver can compensate.
Radiofrequency ablation
Radiofrequency is also an option for tumors 3 to 5 cm in diameter, especially for single, deep lesions away from the major vessels of the liver, and in some patients the efficacy approximates that of surgical resection.
Comprehensive treatment
For patients with advanced relapses for whom liver transplantation, surgical resection, and radiofrequency are not options, combination therapy may also lead to long-term survival in some patients.
Interventional perfusion embolization, oral targeted agents such as sorafenib, and radiation therapy, as well as a combination of these therapies, can provide the greatest benefit.
Immunotherapy
Immunotherapy, represented by programmed death-1 (PD-1) and its ligand (PD-L1), is a useful addition to existing therapies.