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Mathias-Machado et al. Hepatoma Res 2021;7:67 https://dx.doi.org/10.20517/2394-5079.2021.84 Page 3 of 12

Figure 1. Patterns of recurrence after resection or ablation and potential strategies.

SELECTION OF POTENTIAL CANDIDATES FOR ADJUVANT THERAPIES
The risk of recurrence after resection, ablation, or transplantation can be determined by well-defined factors
and other factors that are still unknown. Tumor-related characteristics such as size, number of nodules,
vascular invasion (macroscopic or microscopic), or residual disease after incomplete resection are
significantly related to higher recurrence rates. Genetic signatures, circulating microRNA, and circulating
tumor cells have also been shown to predict the risk of recurrence and can become an important tool for
patient selection .
[4,7]

With the increasing awareness of the role of immunology in HCC, some immunological features are being
considered as potential predictors of recurrence. For example, the concentration of intratumor CD3+ and
CD8+ T cells at tumor resection margins is associated with recurrence. Furthermore, the expression of
programmed death ligand 1 (PD-L1) by immune and tumor cells is associated with tumor aggressiveness
and risk of recurrence .
[8]
Recognition of higher risk characteristics is crucial for clinical trial design and for the appropriate selection
of target populations that may benefit from complementary treatment strategies.

ADJUVANT TREATMENT MODALITIES
IFNα
Some studies conducted in Asia with patients with chronic hepatitis B virus infection suggest that the use of
IFNα may play a role in the adjuvant setting. In a randomized study involving 236 patients with hepatitis B