**3.1 Immunotherapy for early-stage HCC**

Early-stage (BCLC 0 and BCLCA) HCC patients can benefit from treatments such as surgery, liver transplantation, and radiofrequency ablation (RFA) [9]. However, recurrence after liver surgery is prevalent and closely linked to poor overall survival, with recurrence rates of up to 50% and 70% following 2 and 5 years, accordingly [1]. Recurrence is linked to the manifestation of thrombocytopenia, cirrhosis, and satellite lesions [10]. Furthermore, various immunological variables were found with relatively poor resection effects. High PD-L1 expression is linked to an elevated level of immunosuppressive molecules including regulatory T-cells (also known as Tregs) and myeloid-derived suppressor cells (MDSCs) as well as the attenuation of cytotoxic elements such as interferonγ [11–14]. High CD3+ and CD8+ T cell density in the tumor core and margin, as well as related immune scores, which are based on the number of CD3+ and CD8+ lymphocytes in the intratumor (from the tumor core to the periphery), are linked to a much lower probability of HCC recurrence postsurgical treatment [15, 16]. For patients with unresectable HCC or HCC with end-stage liver disease, liver transplantation is an alternate and possibly ideal therapeutic option. However, only a small percentage of HCC patients match the transplant criteria, and the restricted number of transplant centers makes liver transplantation an unrealistic option for many patients due to the chronic shortage of donor organs. Hence, it is needed to combine adjuvant and neoadjuvant immunotherapy to elevate the likelihood of cure post HCC surgery.
