Neoadjuvant and adjuvant treatment strategies for hepatocellular carcinoma

World J Gastroenterol. 2019 Jul 28;25(28):3704-3721. doi: 10.3748/wjg.v25.i28.3704.


Hepatocellular carcinoma (HCC) is the most common liver malignancy worldwide and a major cause of cancer-related mortality for which liver resection is an important curative-intent treatment option. However, many patients present with advanced disease and with underlying chronic liver disease and/or cirrhosis, limiting the proportion of patients who are surgical candidates. In addition, the development of recurrent or de novo cancers following surgical resection is common. These issues have led investigators to evaluate the benefit of neoadjuvant and adjuvant treatment strategies aimed at improving resectability rates and decreasing recurrence rates. While high-level evidence to guide treatment decision making is lacking, recent advances in locoregional and systemic therapies, including antiviral treatment and immunotherapy, raise the prospect of novel approaches that may improve the outcomes of patients with HCC. In this review, we evaluate the evidence for various neoadjuvant and adjuvant therapies and discuss opportunities for future clinical and translational research.

Keywords: Adjuvant therapy; Hepatectomy; Hepatocellular carcinoma; Liver cirrhosis; Neoadjuvant therapy; Neoplasm recurrence.

Publication types

  • Review

MeSH terms

  • Ablation Techniques / methods
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antiviral Agents / therapeutic use
  • Carcinoma, Hepatocellular / pathology
  • Carcinoma, Hepatocellular / therapy*
  • Carcinoma, Hepatocellular / virology
  • Chemoembolization, Therapeutic / methods
  • Chemotherapy, Adjuvant / methods
  • Hepatectomy*
  • Humans
  • Liver / pathology
  • Liver / surgery
  • Liver / virology
  • Liver Neoplasms / pathology
  • Liver Neoplasms / therapy*
  • Liver Neoplasms / virology
  • Neoadjuvant Therapy / methods*
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / therapy*
  • Neoplasm Staging
  • Radiosurgery / methods
  • Treatment Outcome
  • Yttrium Radioisotopes / administration & dosage


  • Antiviral Agents
  • Yttrium Radioisotopes
  • Yttrium-90