Published online Feb 28, 2023. doi: 10.3748/wjg.v29.i8.1243
Peer-review started: September 21, 2022
First decision: January 3, 2023
Revised: January 6, 2023
Accepted: January 30, 2023
Article in press: January 30, 2023
Published online: February 28, 2023
Processing time: 160 Days and 5.1 Hours
Hepatocellular carcinoma (HCC) is the most frequent liver neoplasm, and its incidence rates are constantly increasing. Despite the availability of potentially curative treatments (liver transplantation, surgical resection, thermal ablation), long-term outcomes are affected by a high recurrence rate (up to 70% of cases 5 years after treatment). HCC recurrence within 2 years of treatment is defined as “early” and is generally caused by the occult intrahepatic spread of the primary neoplasm and related to the tumor burden. A recurrence that occurs after 2 years of treatment is defined as “late” and is related to de novo HCC, independent of the primary neoplasm. Early HCC recurrence has a significantly poorer prognosis and outcome than late recurrence. Different pathogenesis corresponds to different predictors of the risk of early or late recurrence. An adequate knowledge of predictive factors and recurrence risk stratification guides the therapeutic strategy and post-treatment surveillance. Patients at high risk of HCC recurrence should be referred to treatments with the lowest recurrence rate and when standardized to combined or adjuvant therapy regimens. This review aimed to expose the recurrence predictors and examine the differences between predictors of early and late recurrence.
Core Tip: Hepatocellular carcinoma is burdened by a high rate of both early and late recurrence. The knowledge of the predictive factors of recurrence and its risk stratification should allow optimization of the management of the patient with hepatocellular carcinoma.