OBJECTIVES: Recurrence following curative-intent resection/ablation for early-stage hepatocellular carcinoma (HCC) occurs in 70–90% of cases within 5 years. This systematic literature review (SLR) identified evidence on the humanistic and economic burden of HCC recurrence following resection or ablation.

METHODS: MEDLINE, Embase, National Health Service Economic Evaluation Database and Health Technology Assessment Database were searched in October 2023, supplemented by grey literature handsearches. Eligible articles reported health-related quality of life (HRQoL) and healthcare resource use (HCRU) data for HCC patients with recurrence following resection/ablation.

RESULTS: This SLR included 34 publications reporting HRQoL (n=3), treatment patterns (n=25) and HCRU (n=12) data, with most studies conducted in Asia. Patients experienced significant improvements in HRQoL following initial curative treatment versus before treatment. However, patients with recurrence experienced significantly reduced HRQoL versus their HRQoL post-initial treatment, or versus those who remained recurrence-free. The most frequently reported treatments for first recurrence were ablation, embolization and resection, with few studies reporting patients receiving no treatment. After recurrence, the cost of repeat resection was substantially higher than for ablation or embolization, with length of hospital stay also higher for resection versus ablation. Patients not receiving treatment for recurrence still incurred substantial costs. The only study reporting indirect costs estimated that ~$0.5 million in earnings are lost per death due to HCC recurrence in the United States.

CONCLUSIONS: Despite limitations in the generalizability of data (most studies reported data collected >10 years ago, from Asia), this SLR shows that HCC recurrence negatively affects HRQoL. Most patients receive active treatment for recurrence, resulting in additional costs and hospitalization. There is an unmet need for treatments post-curative-intent resection/ablation that minimize recurrence risk to reduce the humanistic and economic burden of recurrence, preserving the HRQoL improvements achieved by initial treatment for early-stage HCC and avoiding the need for further treatment and disease management.