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Lookup NU author(s): Abdullah Malik, Dr Daniel Geh, Professor Derek MannORCiD, Steven White
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© Springer Nature Limited 2025.Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. Curative-intent treatments offer the best long-term outcomes for selected patients. However, recurrence rates after resection approach 70% at 5 years, and access to transplantation remains limited by donor scarcity and stringent eligibility criteria. Emerging data reveal that recurrence is a reflection of underlying tumour biology, immune evasion and microenvironmental permissiveness. Advances in immunogenomic profiling, liquid biopsy and functional imaging are reshaping the concept of surgical eligibility, enabling biological risk stratification beyond conventional staging. At the same time, innovations in perioperative immunotherapy, graft preservation using machine perfusion and integrated multidisciplinary care are expanding the boundaries of curative treatment. These developments herald a shift from static criteria to dynamic, biology-driven paradigms that personalize surgical and transplant strategies. In this Review, we examine the evolving landscape of surgical treatment for HCC. We highlight the limitations of current selection frameworks, discuss how biological insights can inform resection and transplant decision-making and explore the role of perioperative and neoadjuvant therapies in reducing the recurrence of disease. Finally, we outline a future precision oncology model that integrates tumour genomics, immune phenotype and regenerative biology to improve outcomes in patients undergoing curative-intent treatment for HCC.
Author(s): Malik AK, Geh D, Jeffry Evans TR, Chow PKH, Mann DA, White SA
Publication type: Review
Publication status: Published
Journal: Nature Reviews Gastroenterology and Hepatology
Year: 2025
Pages: epub ahead of print
Online publication date: 17/11/2025
Acceptance date: 14/10/2025
ISSN (print): 1759-5045
ISSN (electronic): 1759-5053
Publisher: Nature Research
URL: https://doi.org/10.1038/s41575-025-01143-y
DOI: 10.1038/s41575-025-01143-y
PubMed id: 41249657
