Surgical resection and liver transplantation are the only curative therapies for hepatocellular carcinoma (HCC); however, fewer than 20% of patients are eligible for these therapies.1 Surgical resection is the treatment of choice for HCC in patients with a solitary tumor and no evidence of cirrhosis; this disease pattern accounts for roughly 5% of HCC in western countries and 40% in Asia.1 The higher percentage of HCC patients in Asia who are amenable to surgical resection is related to the predominance of hepatitis B virus (HBV)–related HCC, which can occur in the absence of cirrhosis. Improvement in early diagnosis of HCC and more accurate evaluation of underlying liver function have resulted in 5-year survival after resection for HCC exceeding 50%.1 Nevertheless, despite careful selection, HCC recurrence rate after surgical resection is high: 50% to 70% at 5 years.1 None of the adjuvant therapies prior to or immediately following resection have been shown to reduce the rate of HCC recurrence.
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