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HCC Recurrence After Curative Intent Treatment: The Need for New High-Risk Criteria in the Context of Adjuvant Therapy
Journal article   Open access   Peer reviewed

HCC Recurrence After Curative Intent Treatment: The Need for New High-Risk Criteria in the Context of Adjuvant Therapy

Natalie Commins, Rohit Gupta, Andrew Sloss, Tehara Wickremeratne, Roger Wilson, Jonathan Langton, Brooke Gaggin and James O’Beirne
Livers, Vol.6(2), pp.1-13
2026
DOI: https://doi.org/10.3390/livers6020014
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Published Version Open Access CC BY V4.0

Abstract

hepatocellular carcinoma immunotherapy hepatology adjuvant therapy IMbrave050
Background and Aim: Adjuvant therapy after curative intent treatment for hepatocellular carcinoma (HCC) is a significant unmet need. The IMbrave050 study demonstrated improved recurrence-free survival (RFS) in patients with high-risk HCC receiving adjuvant atezolizumab and bevacizumab post-curative treatment compared to active surveillance. However, the IMbrave050 cohort was predominantly Asian, largely underwent surgical resection, and had chronic liver disease (CLD) mainly due to hepatitis B features that differ markedly from the Australian setting, where microwave ablation (MWA) is more common and hepatitis B-related CLD is less prevalent. Given these differences, this study aimed to explore the performance of the IMbrave050 risk criteria in an Australian population of patients with early-stage HCC undergoing curative treatment to determine if the criteria identified patients with a high risk of recurrence who may benefit from adjuvant treatment. Method: We performed a retrospective 5-year study of 50 patients with early-stage HCC undergoing MWA with curative intent or liver resection. Patients were stratified into high- and low-risk groups using the IMbrave050 criteria. The primary outcomes were RFS and overall survival (OS) in the high- and low-risk cohorts. Results: For patients who underwent liver resection, the 1-year RFS was 77.8% and 100% in high- and low-risk patients respectively (p = NS). In those who underwent MWA, the 1-year RFS was 89.5% in the high-risk cohort and 73.3% in the low-risk cohort (p = NS). OS at 1-year was 100% in all cohorts (p = NS). Conclusions: In this Western cohort receiving predominantly ablation as curative therapy the current high-risk criteria do not reliably distinguish between those with increased risk of early recurrence and those without. Criteria defining high-risk may need to be refined to better identify patients who may benefit from adjuvant therapy in this setting.

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