Although
hepatocellular carcinoma (HCC) is associated with a poor prognosis, management of early-stage HCC is often successful with highly efficacious treatment modalities such as
liver transplantation, surgical resection, and
radiofrequency ablation. However, unfavorable clinical outcomes have been observed under certain circumstances, even after efficient treatment. Factors that predict unsuitable results
after treatment include
tumor markers, inflammatory markers, imaging findings reflecting
tumor biology, specific outcome indicators for each treatment modality, liver functional reserve, and the technical feasibility of the treatment modalities. Various strategies may overcome these challenges, including the application of reinforced treatment indication criteria with predictive markers reflecting
tumor biology, compensation for technical issues with up-to-date technologies, modification of treatment modalities, downstaging with locoregional
therapies (such as transarterial
chemotherapy or
radiotherapy), and recently introduced combination
immunotherapies. In this review, we discuss the challenges to achieving optimal outcomes in the management of early-stage HCC and suggest strategies to overcome these obstacles.