Adjuvant Immunotherapy in HCC: JGH | March 2026

Introduction

Hepatocellular carcinoma remains a major global cancer burden, with high recurrence rates even after curative therapies such as resection or ablation. Historically, effective adjuvant treatments have been lacking, and surveillance has been the standard approach. With the success of immune checkpoint inhibitors in advanced HCC, there is growing interest in moving these therapies earlier into the adjuvant setting to reduce recurrence and improve survival outcomes.

Problem Statement

The role of immune checkpoint inhibitors as adjuvant therapy after curative treatment of HCC remains uncertain, with conflicting evidence and lack of definitive randomized trial data.

Summary

This meta-analysis of 18 studies involving over 3400 patients provides encouraging evidence that ICI-based adjuvant therapy significantly improves outcomes compared with surveillance alone. Recurrence-free survival was nearly halved (HR ~0.51), and overall survival also showed a meaningful improvement. Importantly, both ICI monotherapy and combination strategies with TKIs or anti-angiogenic agents demonstrated similar benefits, suggesting flexibility in therapeutic approaches.

The benefit was consistent across subgroups, including patients undergoing resection or ablation, and regardless of prior treatments such as TACE. This reinforces the potential of immunotherapy to address the key challenge of post-curative recurrence.

However, the evidence is largely derived from observational and region-specific studies, limiting generalizability. High-quality global randomized phase III trials with longer follow-up are urgently needed before routine adoption.

Clinically, this study signals a paradigm shift—from passive surveillance to active adjuvant intervention—but caution is warranted until stronger prospective data confirm these findings.