From the Guidelines
For patients with T1b N0 hepatocellular carcinoma (HCC) after resection, regular surveillance is crucial to monitor for recurrence. This should include:
Imaging Studies
- Multiphasic cross-sectional imaging, such as CT or MRI, every 3 to 6 months for 2 years, then every 6 to 12 months thereafter 1
- The use of CT or MRI is preferred over ultrasound due to their higher sensitivity in detecting HCC recurrence, especially in patients with cirrhosis or nodular liver disease 1
Tumor Marker Surveillance
- Alpha-fetoprotein (AFP) levels should be checked every 3 months for 2 years, then every 6 to 12 months thereafter 1
- Elevated AFP levels are associated with poor prognosis after treatment and should be closely monitored 1
Liver Function Tests
- Regular monitoring of liver function, including liver enzymes and bilirubin levels, to assess for any signs of liver dysfunction or recurrence Additionally, consideration should be given to managing underlying liver disease, such as hepatitis B or C, with appropriate antiviral therapy to reduce the risk of HCC recurrence 1. Lifestyle modifications, including avoidance of alcohol and maintenance of a healthy weight, are also recommended to reduce the risk of HCC recurrence. The choice of imaging modality and frequency may vary depending on individual patient factors, such as the presence of cirrhosis or previous liver-directed therapy 1.
From the Research
Surveillance Recommendations for T1b (Solitary Tumor Less Than 2 cm) N0 Hepatocellular Carcinoma (HCC) Post-Resection
- The optimal frequency and method of surveillance for recurrent HCC after curative intent treatment is not directly guided by evidence, however, close surveillance with α-fetoprotein and cross-sectional imaging every 3-4 months for 3 years after curative intent therapy, followed by surveillance every 6-12 months thereafter, seems a prudent approach 2.
- Factors associated with recurrence and aggressive recurrence, such as microvascular invasion and/or satellitosis, tumor size, and multiplicity, should be considered when determining the surveillance strategy 3, 4, 5.
- Predictors of early and late recurrence, including preoperative alpha-fetoprotein level, resection margin, and tumor characteristics, can inform the intensity and duration of surveillance 5.
- Regular postoperative surveillance is crucial, as irregular surveillance is associated with worse post-recurrence survival 5.
- Adjuvant therapies, such as antiviral therapy with nucleoside analogs for HBV-related HCC, may be considered to prevent recurrence, but their effectiveness is still being studied 6.