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World J Gastroenterol. May 28, 2014; 20(20): 5935-5950
Published online May 28, 2014. doi: 10.3748/wjg.v20.i20.5935
Prognostic factors for hepatocellular carcinoma recurrence
Antonio Colecchia, Ramona Schiumerini, Alessandro Cucchetti, Matteo Cescon, Martina Taddia, Giovanni Marasco, Davide Festi
Antonio Colecchia, Ramona Schiumerini, Martina Taddia, Giovanni Marasco, Davide Festi, Department of Gastrointestinal Diseases and Internal Medicine, University of Bologna, 40138 Bologna, Italy
Alessandro Cucchetti, Matteo Cescon, Department of General Surgery and Transplants, University of Bologna, 40138 Bologna, Italy
Author contributions: Colecchia A, Schiumerini R, Taddia M and Marasco G collected the data available regarding the medical aspects of hepatocellular recurrence; Cucchetti A and Cescon M collected the data available regarding the surgical aspects of hepatocellular recurrence; Colecchia A and Festi D wrote the manuscript.
Correspondence to: Antonio Colecchia, MD, Department of Gastrointestinal Diseases and Internal Medicine, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Telephone: +39-51-6364110 Fax: +39-51-6364110
Received: September 25, 2013
Revised: February 20, 2014
Accepted: April 27, 2014
Published online: May 28, 2014

The recurrence of hepatocellular carcinoma, the sixth most common neoplasm and the third leading cause of cancer-related mortality worldwide, represents an important clinical problem, since it may occur after both surgical and medical treatment. The recurrence rate involves 2 phases: an early phase and a late phase. The early phase usually occurs within 2 years after resection; it is mainly related to local invasion and intrahepatic metastases and, therefore, to the intrinsic biology of the tumor. On the other hand, the late phase occurs more than 2 years after surgery and is mainly related to de novo tumor formation as a consequence of the carcinogenic cirrhotic environment. Since recent studies have reported that early and late recurrences may have different risk factors, it is clinically important to recognize these factors in the individual patient as soon as possible. The aim of this review was, therefore, to identify predicting factors for the recurrence of hepatocellular carcinoma, by means of invasive and non-invasive methods, according to the different therapeutic strategies available. In particular the role of emerging techniques (e.g., transient elastography) and biological features of hepatocellular carcinoma in predicting recurrence have been discussed. In particular, invasive methods were differentiated from non-invasive ones for research purposes, taking into consideration the emerging role of the genetic signature of hepatocellular carcinoma in order to better allocate treatment strategies and surveillance follow-up in patients with this type of tumor.

Keywords: Percutaneous ethanol injection, Percutaneous radiofrequency ablation, Transarterial chemoembolization, Hepatic resection, Orthotopic liver transplant, Liver biopsy, Liver stiffness measurement, Hepatocellular carcinoma

Core tip: Hepatocellular carcinoma (HCC) recurrence represents an important clinical challenge due to its negative impact on overall patient survival. The predictors of HCC recurrence, based mainly on HCC radiological features (i.e., number and size of HCC nodules), have enabled early diagnosis thereby drastically reducing the HCC recurrence rate and, hence, patient survival. However, other more efficacious predictors are needed in order to further reduce the HCC recurrence rate. This review describes the more clinically useful predictors of the different imaging techniques and the molecular features of HCC recurrence according to the available therapeutic strategies.