Journal of Gastrointestinal Cancer

, Volume 48, Issue 3, pp 274–275 | Cite as

Hepatocellular Cancer: Is Recurrence Inevitable?

  • Levent DoganayEmail author
Review Article


Hepatocellular cancer (HCC) ranks as the sixth common cancer in the world [1]. Yearly, it is estimated that more than 700,000 people are diagnosed with HCC. However, when it comes to mortality, it is the second cause [1, 2]. More than half of the HCC patients are from East Asia and the most prevalent liver disease causing HCC is chronic hepatitis B (HBV) infection there. The other underlying disorders are chronic hepatitis C infection, alcohol abuse, and metabolic syndrome. Tobacco smoking and dietary aflatoxin exposure are additional confounding factors [3].

Despite advances in medicine, recurrence after HCC treatment are unacceptably high. In the long-term recurrence, free survival is less than 40% after loco-regional treatments [4]. Here, the current literature in recurrence of HCC is reviewed.

Curative Strategies in HCC Treatment and Recurrence

HCC treatment algorithm is not built on a TNM staging system. Barcelona Clinic Liver Cancer (BCLC) staging system in wide use,...


  1. 1.
    Forman D, Ferlay J. The global and regional burden of cancer. In: Stewart BW, Wild CP, editors. World cancer report. Lyon: IARCPress; 2014. p. 16–53.Google Scholar
  2. 2.
    Mortality GBD. Causes of Death C. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1459–544.CrossRefGoogle Scholar
  3. 3.
    Llovet JM, Zucman-Rossi J, Pikarsky E, Sangro B, Schwartz M, Sherman M, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2016;2:16018.CrossRefPubMedGoogle Scholar
  4. 4.
    Wang Y, Luo Q, Li Y, Deng S, Wei S, Li X. Radiofrequency ablation versus hepatic resection for small hepatocellular carcinomas: a meta-analysis of randomized and nonrandomized controlled trials. PLoS One. 2014;9(1):e84484.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379(9822):1245–55.CrossRefPubMedGoogle Scholar
  6. 6.
    Livraghi T, Meloni F, Di Stasi M, Rolle E, Solbiati L, Tinelli C, et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology. 2008;47(1):82–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Taefi A, Abrishami A, Nasseri-Moghaddam S, Eghtesad B, Sherman M. Surgical resection versus liver transplant for patients with hepatocellular carcinoma. Cochrane Database Syst rev. 2013;6:CD006935.Google Scholar
  8. 8.
    Rahman A, Assifi MM, Pedroso FE, Maley WR, Sola JE, Lavu H, et al. Is resection equivalent to transplantation for early cirrhotic patients with hepatocellular carcinoma? A Meta-Analysis J Gastrointest Surg. 2012;16(10):1897–909.CrossRefPubMedGoogle Scholar
  9. 9.
    Marubashi S, Gotoh K, Akita H, Takahashi H, Ito Y, Yano M, et al. Anatomical versus non-anatomical resection for hepatocellular carcinoma. Br J Surg. 2015;102(7):776–84.CrossRefPubMedGoogle Scholar
  10. 10.
    Sasaki K, Shindoh J, Margonis GA, Nishioka Y, Andreatos N, Sekine A, et al. Effect of background liver cirrhosis on outcomes of hepatectomy for hepatocellular carcinoma. JAMA Surg. 2017:e165059.Google Scholar
  11. 11.
    Bruix J, Takayama T, Mazzaferro V, Chau GY, Yang J, Kudo M, et al. Adjuvant sorafenib for hepatocellular carcinoma after resection or ablation (STORM): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2015;16(13):1344–54.CrossRefPubMedGoogle Scholar
  12. 12.
    Toso C, Asthana S, Bigam DL, Shapiro AM, Kneteman NM. Reassessing selection criteria prior to liver transplantation for hepatocellular carcinoma utilizing the scientific registry of transplant recipients database. Hepatology. 2009;49(3):832–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Mazzaferro V, Bhoori S, Sposito C, Bongini M, Langer M, Miceli R, et al. Milan criteria in liver transplantation for hepatocellular carcinoma: an evidence-based analysis of 15 years of experience. Liver Transpl. 2011;17(Suppl 2):S44–57.CrossRefPubMedGoogle Scholar
  14. 14.
    Wu CY, Chen YJ, Ho HJ, Hsu YC, Kuo KN, Wu MS, et al. Association between nucleoside analogues and risk of hepatitis B virus-related hepatocellular carcinoma recurrence following liver resection. JAMA. 2012;308(18):1906–14.CrossRefPubMedGoogle Scholar
  15. 15.
    van der Meer AJ, Wedemeyer H, Feld JJ, Dufour JF, Zeuzem S, Hansen BE, et al. Life expectancy in patients with chronic HCV infection and cirrhosis compared with a general population. JAMA. 2014;312(18):1927–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Zavaglia C, Okolicsanyi S, Cesarini L, Mazzarelli C, Pontecorvi V, Ciaccio A, et al. Is the risk of neoplastic recurrence increased after prescribing direct-acting antivirals for HCV patients whose HCC was previously cured? J Hepatol. 2017;66(1):236–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Chan KM, Kuo CF, Hsu JT, Chiou MJ, Wang YC, Wu TH, et al. Metformin confers risk reduction for developing hepatocellular carcinoma recurrence after liver resection. Liver Int. 2017;37(3):434–41.CrossRefPubMedGoogle Scholar
  18. 18.
    Geissler EK, Schnitzbauer AA, Zulke C, Lamby PE, Proneth A, Duvoux C, et al. Sirolimus use in liver transplant recipients with hepatocellular carcinoma: a randomized, multicenter, open-label phase 3 trial. Transplantation. 2016;100(1):116–25.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Gastroenterology and HepatologyUmraniye Teaching and Research HospitalIstanbulTurkey
  2. 2.Gastroenteroloji KlinigiUmraniye Egitim ve Arastirma HastanesiIstanbulTurkey

Personalised recommendations