Thermal ablation therapy for hepatocellular carcinoma: recurrence mechanisms and intervention strategies

Thermal ablation, including radiofrequency ablation and microwave ablation, is a critical treatment modality for early-stage hepatocellular carcinoma (HCC); however, the high postoperative recurrence rate remains a significant challenge. Underlying mechanisms of post-ablation recurrence - including autophagy, epithelial-mesenchymal transition, hypoxic microenvironment formation, and immune suppression - are being progressively elucidated. Insufficient ablation is considered a key initiating factor for these processes. Advanced imaging techniques have thus been developed to improve intraprocedural monitoring and margin assessment, aiming to prevent insufficient ablation. For cases with confirmed residual or recurrent tumors, integrated therapies such as transarterial chemoembolization, radiotherapy, immunotherapy, and nanomedicine offer promising salvage options to mitigate further recurrence and improve survival. This review summarizes the mechanisms of tumor recurrence following HCC ablation and discusses potential countermeasures, aiming to provide valuable insights for clinical practice.