In this special symposium of “multidisciplinary treatment of HCC” including HCC treatment according to BCLC guidelines, multidisciplinary non-surgical treatment, resection, liver transplantation, and chemoprevention for post-operative HCC recurrence have been well presented and discussed. However, the following issues across various stage of HCC remain unresolved or controversial.
1. For very early stage HCC i.e. solitary and smaller than 2cm, both resection and RFA with tumor non-touching ablation method by multi-electrodes are being applicable. Overall survival might be comparable and the similar recurrence-free survival rate can also be anticipated.
2. RFA with multi-electrodes can be effectively utilized for medium-size（3-5cm）or large（＞5cm but better ＜7cm）HCC. However, pre-ablation adjuvant therapies with systemic agents or TACE to enlarge ablation zone remain challenges for operators.
3. For early or intermediate stage HCC, resection can be accepted in selected case with preserved liver function and anatomically resectable tumors. However, RFA or MWA（microwave ablation）alone or combination with TACE can also be applied for selected cases with 1-4 tumors and maximal dimension of 7cm, particularly after application of novel RFA or MWA. The benefits of adjuvant therapies with anti-cancer agents including target therapy remain uncertain.
4. For advanced HCC with tumor invasion of small branches of PV or HV, either sorafenib alone（only accepted by AASLD and EASL guidelines）or combination with radiotherapy, HAIC or TACE remain controversial in determining their survival benefits.
5. For advanced HCC, sorafenib remains the standard of treatment. Beyond sorafenib, Brivanib and Afinitor failed in the 2nd line study. However, Kurume and Okayama Liver Cancer Study Groups showed that sorafenib administration beyond first radiological progression PD could continuously suppress HCC growth and may have survival benefit and suggested that sorafenib should be administered as a long-term treatment for advanced HCC regardless of therapeutic effect and dosage. However, more validation still required.
6. Finally, tertiary prevention after resection or curative ablation with interferon or anti-cancer agents including sorafenib remains uncertain although few limited reports showed promising effects.