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we think that effective adjuvant therapy in addition to preoperative HAIC is crucial for further improved
prognosis, we could not show the sufficient efficacy of adjuvant chemotherapy. Further prospective
multicenter trials are required to establish the effectiveness of neoadjuvant HAIC for the treatment of HCC.

In conclusion, neoadjuvant HAIC for patients with HCC with a high-grade malignant phenotype decreases
the risk of recurrence and improves survival without serious complications. However, a prospective
randomized study is required to confirm our findings.

DECLARATIONS
Author’s contributions
Conceived of the presented idea and developed theory: Tsutsui R, Nagamatsu H, Itano O
Contributed to the interpretation of the results: Deguchi A, Tsutsumi T, Hiraki M, Mizukami N, Akiba J
Provided critical feedback and helped shape the research, analysis and manuscript: Tsutsui R, Nagamatsu H,
Itano O, Deguchi A, Tsutsumi T, Hiraki M, Mizukami N, Akiban J

Data source and availability
The data presented is original and obtained in our laboratory. It is available with the authors and can be
made available if required.

Financial support and sponsorship
None.

Conflicts of interest
There are no conflicts of interest.

Patient consent
Written informed consent from all the patients of the treatment group was obtained as part of the involvement
in this study.

Ethics approval
The study was reviewed and approved by the Yame General Hospital Institutional Review Board.

Copyright
© The Author(s) 2018.

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