Interferon: the magic bullet to prevent hepatocellular carcinoma recurrence after resection?

摘要

Hepatocellular carcinoma (HCC) is the third most common cause of death from cancer in men and the sixth most common cause in women. Its incidence is rising faster than most other cancers due to the increasing prevalence of hepatitis B (HB V) and C (HCV) infection. Among the curative treatments, liver transplantation can only be offered to a small proportion of patients due to graft availability, selection criteria, and high cost. Therefore, liver resection, or perhaps ablation, remains the sole available therapy in many situations. While liver resection can be performed with a mortality rate below 5% in cirrhotic patients with well preserved liver function and an absence of portal hypertension in specialized centers, more than half of these patients developed recurrent HCC within 5 years of surgery despite clear resection margins (RO). Recurrences should be differentiated into 2 categories: early and late recurrences. Early recurrent HCCs are the results of residual hepatic tumors left behind after a presumably RO resection; usually, such tumors will become apparent within 2 years of surgery. In contrast, late (also called de novo) tumors are new, typically occurring more than 2 years after surgery, as the result of the underlying procarcinogenic liver disease or virus with the highest risk in patients with hepatitis B or C. This distinction is important as neoadjuvant or adjuvant therapies may be effective in only 1 type of recurrence. Another feature that may impact the outcome as well as tolerance of therapies added to liver resection is the presence and severity of the underlying liver disease; for example, in hepatitis B patients, HCC may occur without cirrhosis, while cirrhosis is consistently present in HCC related to HCV.